MEDICARE: RADIATION THERAPY ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0203X	Radiation Oncology Clinic/Center	A0602A2	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649379553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIATION THERAPY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	2620 PEERLESS RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3732
Country	:	US
Telephone Number	:	423-472-2171
Fax Number	:	423-472-0060

Provider Business Practice Location Address
First Line	:	2620 PEERLESS RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3732
Country	:	US
Telephone Number	:	423-472-2171
Fax Number	:	423-472-0060

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LISA JUNE VIROSTEK
Credential	:	MD
Telephone Number	:	423-472-2171

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	06/22/2016

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