=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295785970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAK RIDGE SURGEONS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 07/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 ADMINISTRATION RD
-----------------------------------------------------
City | OAK RIDGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37830-8822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-483-7030
-----------------------------------------------------
Fax | 865-483-3954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 ADMINISTRATION RD
-----------------------------------------------------
City | OAK RIDGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37830-8822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-483-7030
-----------------------------------------------------
Fax | 865-483-3954
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WILLIAM S DALLAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 865-483-7030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | NO STATE LIC FOR GRO
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------