1205862927 NPI number — EASTERN WOODS RADIATION ONCOLOGY

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 1205862927 NPI number — EASTERN WOODS RADIATION ONCOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN WOODS RADIATION ONCOLOGY
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:
Provider Other Organization Name Type Code:
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:
1205862927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43697-0330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-430-5712
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15990 MEDICAL DR S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FINDLAY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45840-8894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-423-4500
Provider Business Practice Location Address Fax Number:
419-427-0212
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUTZ
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
419-423-3703

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: 2401921 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA1414 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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