Healthcare Provider Details

I. General information

NPI: 1275514697
Provider Name (Legal Business Name): TENNESSEE HDR MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7551 DANNAHER WAY
POWELL TN
37849-4029
US

IV. Provider business mailing address

7551 DANNAHER WAY
POWELL TN
37849-4029
US

V. Phone/Fax

Practice location:
  • Phone: 865-859-7020
  • Fax: 865-859-3706
Mailing address:
  • Phone: 865-859-7020
  • Fax: 865-859-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number StateTN

VIII. Authorized Official

Name: MR. JACK M BRYAN
Title or Position: GOVERNOR AND COC
Credential:
Phone: 865-859-1337