MEDICARE: TENNESSEE CANCER SPECIALISTS

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	332900000X	Non-Pharmacy Dispensing Site	4453298	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4439700	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1922181114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE CANCER SPECIALISTS

Provider Business Mailing Address
First Line	:	900 E HILL AVE
Second Line	:	STE 230
City	:	KNOXVILLE
State	:	TN
Zip	:	37915-2566
Country	:	US
Telephone Number	:	865-862-0998
Fax Number	:	865-544-1861

Provider Business Practice Location Address
First Line	:	7551 DANNAHER WAY
Second Line	:
City	:	POWELL
State	:	TN
Zip	:	37849-4029
Country	:	US
Telephone Number	:	865-637-9330
Fax Number	:	865-512-6748

Authorized Official
Title or Position	:	CHIEF MANAGER
Name	:	MITCHELL D MARTIN
Credential	:	M.D.
Telephone Number	:	865-637-9330

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/14/2016

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