1447365945 NPI number — CENTRAL VIRGINIA ONCOLOGY, INC.

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 1447365945 NPI number — CENTRAL VIRGINIA ONCOLOGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL VIRGINIA ONCOLOGY, INC.
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:
PETERSBURG ONCOLOGY, INC
Provider Other Organization Name Type Code:
4
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:
1447365945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 S SYCAMORE ST
Provider Second Line Business Mailing Address:
STE 10
Provider Business Mailing Address City Name:
PETERSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-732-7900
Provider Business Mailing Address Fax Number:
804-732-7592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 S SYCAMORE ST
Provider Second Line Business Practice Location Address:
STE 10
Provider Business Practice Location Address City Name:
PETERSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-732-7900
Provider Business Practice Location Address Fax Number:
804-732-7592
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FUKUMOTO
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
PRES, UP, SEC, TREAS
Authorized Official Telephone Number:
804-732-7900

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101030480 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 274304 . This is a "BLUE CROSS AND BLUE SHELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 6090575 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3600128 . This is a "UNITED HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 112949936 . This is a "MEDICARE ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00145587 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 59455 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 268028 . This is a "MAMIS/OPT.CHOICE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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