Healthcare Provider Details

I. General information

NPI: 1972708915
Provider Name (Legal Business Name): RADIATION ONCOLOGY MEMPHIS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 PARK AVE DEPARTMENT OF RADIATION ONCOLOGY
MEMPHIS TN
38119-5200
US

IV. Provider business mailing address

PO BOX 2044 DEPT 2600
MEMPHIS TN
38101-2044
US

V. Phone/Fax

Practice location:
  • Phone: 901-821-0338
  • Fax: 901-821-0384
Mailing address:
  • Phone: 901-821-0338
  • Fax: 901-821-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberMD0000036209
License Number StateTN

VIII. Authorized Official

Name: MR. MARLENE K WRIGHT IV
Title or Position: BILLING MANAGER
Credential:
Phone: 901-821-0338