44D1083231 CLIA NUMBER - CANCER CARE, PLLC DBA CLARKSVILLE CANCER CARE

Laboratory Demographics

CLIA Number: 44D1083231

Facility Name: CANCER CARE, PLLC DBA CLARKSVILLE CANCER CARE

Facility Address:
274 CLEAR SKY COURT
CLARKSVILLE, TN
ZIP 37043
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Facility Phone Number: 931 802-8056

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1265628226

Taxonomy: 207RH0003X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

CLIA Record

Field Name	Field Value
CLIA Number	44D1083231
LAB Type	Physician Office
Facility Name	CANCER CARE, PLLC DBA CLARKSVILLE CANCER CARE
Street	274 CLEAR SKY COURT
City	CLARKSVILLE
State	TN
ZIP	37043
Phone	931 802-8056
CertificateType	4
CertificateEffectiveDate	10/2/2023
CertificateExpirationDate	10/1/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024