1285687178 NPI number — COMMONWEALTH HEMATOLOGY ONCOLOGY PSC

Table of content: (NPI 1285687178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285687178 NPI number — COMMONWEALTH HEMATOLOGY ONCOLOGY PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH HEMATOLOGY ONCOLOGY PSC
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:
COMMONWEALTH 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:
1285687178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 TECHWOOD DRIVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40422-8500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-936-9844
Provider Business Mailing Address Fax Number:
859-236-0320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 TECHWOOD DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40422-8500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-936-9844
Provider Business Practice Location Address Fax Number:
859-236-0320
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KASSEM
Authorized Official First Name:
BACHAR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
606-677-1451

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 78903879 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000060792 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2435612000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6593160 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1083462 . This is a "PASSPORT HEALTH CARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CA8281 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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