1831272020 NPI number — TENNESSEE CANCER SPECIALISTS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831272020 NPI number — TENNESSEE CANCER SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENNESSEE CANCER SPECIALISTS
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:
RAYMOND BRIG MD
Provider Other Organization Name Type Code:
3
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:
1831272020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E BLOUNT AVE
Provider Second Line Business Practice Location Address:
STE 610
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37920-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-934-5800
Provider Business Practice Location Address Fax Number:
865-934-5800
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHIEF MANAGER
Authorized Official Telephone Number:
865-637-9330

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4439712 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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