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General NPI Number Information
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NPI Number | 1275514697
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Entity Type | Organization
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Legal Business Name | TENNESSEE HDR MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 7551 DANNAHER WAY
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City | POWELL
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State | TN
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Zip | 37849-4029
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Country | US
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Telephone | 865-859-7020
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Fax | 865-859-3706
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Provider Business Mailing Address
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Address Line | 7551 DANNAHER WAY
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City | POWELL
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State | TN
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Zip | 37849-4029
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Country | US
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Telephone | 865-859-7020
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Fax | 865-859-3706
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Authorized Official
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Title or Position | GOVERNOR AND COC
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Name | MR. JACK M BRYAN
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Credential |
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Telephone | 865-859-1337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number |
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License Number State | TN
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