Basic Information
| Provider Information | |||||||||
| NPI: | 1376873208 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHONE CLINIC SERVICES - ONCOLOGY HEMATOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 HEALTH PARK DR | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153725426 | ||||||||
| FaxNumber: | 3035848141 | ||||||||
| Practice Location | |||||||||
| Address1: | 1721 E 19TH AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7207544800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2009 | ||||||||
| LastUpdateDate: | 04/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | SMITHAM | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DVP/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3035848119 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 26708361 | 05 | CO | MEDICAID | 78938775 | 05 | CO | MEDICAID | 08131368 | 05 | CO | MEDICAID | 77651588 | 05 | CO | MEDICAID | 31952828 | 05 | CO | MEDICAID |