1114906856 NPI number — PENN VIEW RADIATION ONCOLOGY, LTD

Table of content: (NPI 1114906856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114906856 NPI number — PENN VIEW RADIATION ONCOLOGY, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENN VIEW RADIATION ONCOLOGY, LTD
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:
PENN VIEW RADIATION ONCOLOGY
Provider Other Organization Name Type Code:
5
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:
1114906856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 892
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORDVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19331-0892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-412-3192
Provider Business Mailing Address Fax Number:
610-372-3735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 HORIZON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHALFONT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18914-3967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-412-3192
Provider Business Practice Location Address Fax Number:
610-372-3735
Provider Enumeration Date:
01/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HIGHTOWER
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-822-9062

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0018273990005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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