1538245451 NPI number — WESTERN KENTUCKY RADIATION ONCOLOGY

Table of content: (NPI 1538245451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538245451 NPI number — WESTERN KENTUCKY RADIATION ONCOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN KENTUCKY 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:
1538245451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27516-6503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-967-6646
Provider Business Mailing Address Fax Number:
919-967-6647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 E 18TH ST
Provider Second Line Business Practice Location Address:
SUITE 156
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-3752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-432-1072
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHUSTER
Authorized Official First Name:
GRAE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
402-432-1072

Provider Taxonomy Codes

  • Taxonomy code: 2085R0203X , with the licence number:  TP861 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com