Healthcare Provider Details
I. General information
NPI: 1881880961
Provider Name (Legal Business Name): COLUMBIA RADIATION ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
509 E BELL ST
MURFREESBORO TN
37130-3059
US
IV. Provider business mailing address
PO BOX 968
SPRINGFIELD TN
37172-0968
US
V. Phone/Fax
- Phone: 615-396-5530
- Fax: 615-382-8056
- Phone: 615-382-8863
- Fax: 615-382-8056
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 174400000X |
| Taxonomy | Specialist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
CHARLES
D
WENDT
Title or Position: PHYSICIAN / OWNER
Credential: M.D.
Phone: 615-396-5530