MEDICARE: TENNESSEE CANCER SPECIALIST PLLC

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	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1871301358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE CANCER SPECIALIST PLLC

Provider Business Mailing Address
First Line	:	900 E HILL AVE STE 230
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37915-2565
Country	:	US
Telephone Number	:	865-862-0998
Fax Number	:	865-544-1861

Provider Business Practice Location Address
First Line	:	1665 E ANDREW JOHNSON HWY STE 2
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-5826
Country	:	US
Telephone Number	:	423-639-0243
Fax Number	:	423-639-0629

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	PATRICIA G JENKINS
Credential	:
Telephone Number	:	865-862-0998

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	12/30/2024

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