=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386020782
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIG CENTER FOR CANCER CARE AND SURVIVORSHIP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2015
-----------------------------------------------------
Last Update Date | 05/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 DOWELL SPRINGS BLVD STE 200
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37909-2457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-246-1958
-----------------------------------------------------
Fax | 865-246-0955
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 52167
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37950-2167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-246-1958
-----------------------------------------------------
Fax | 865-246-0955
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAYMOND BRIG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 865-246-1958
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 024684
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------