1487847802 NPI number — MIDDLE TENNESSEE RADIATION ONCOLOGY SERVICES, PC

Table of content: (NPI 1487847802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487847802 NPI number — MIDDLE TENNESSEE RADIATION ONCOLOGY SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDDLE TENNESSEE RADIATION ONCOLOGY SERVICES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487847802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 STONECREST BLVD
Provider Second Line Business Mailing Address:
STE 155
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37167-5688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-768-2855
Provider Business Mailing Address Fax Number:
615-768-2856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 STONECREST BLVD
Provider Second Line Business Practice Location Address:
STE 155
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37167-5688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-768-2855
Provider Business Practice Location Address Fax Number:
615-768-2856
Provider Enumeration Date:
08/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
MAURA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-768-2855

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TN0101 . This is a "AMERICHOICE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 10082401 . This is a "AMERIGROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3715295 . This is a "TNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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