1003878232 NPI number — KP ONCOLOGY LLP

Table of content: (NPI 1003878232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003878232 NPI number — KP ONCOLOGY LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KP ONCOLOGY LLP
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:
COLUMBIA COUNTY CANCER CENTER
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:
1003878232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 GRAMPIAN BLVD
Provider Second Line Business Mailing Address:
STE 3A
Provider Business Mailing Address City Name:
WILLIAMSPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17701-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-322-4025
Provider Business Mailing Address Fax Number:
570-322-6403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 SEIPLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17815-7755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-387-9020
Provider Business Practice Location Address Fax Number:
570-387-9021
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KARP
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
570-387-9020

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: 020420800 . This is a "FEDERAL BLACK LUNG PROGRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101158498 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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