Basic Information
| Provider Information | |||||||||
| NPI: | 1972705770 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER RADIATION ONCOLOGY SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16506 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275166506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664575196 | ||||||||
| FaxNumber: | 9199676647 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 E OAK HILL AVE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379174505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655457817 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 08/01/2007 | ||||||||
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| AuthorizedOfficialLastName: | BOPPANA | ||||||||
| AuthorizedOfficialFirstName: | SRINIVAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8655453110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.