MEDICARE: HEALTHONE CLINIC SERVICES - ONCOLOGY HEMATOLOGY LLC

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	207RH0000X	Hematology (Internal Medicine) Physician

General Provider Information

NPI Number	:	1952197253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHONE CLINIC SERVICES - ONCOLOGY HEMATOLOGY LLC

Provider Business Mailing Address
First Line	:	2000 HEALTH PARK DR
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4692
Country	:	US
Telephone Number	:	615-373-7406
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 W 15TH ST STE 200
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2716
Country	:	US
Telephone Number	:	719-296-6000
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	NICHOLAS F WADLINGTON
Credential	:
Telephone Number	:	972-401-9807

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	04/15/2025

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