1568402360 NPI number — ONCOLOGY CENTER OF THE SOUTHWEST, PA

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 1568402360 NPI number — ONCOLOGY CENTER OF THE SOUTHWEST, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONCOLOGY CENTER OF THE SOUTHWEST, PA
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:
NARESH GUPTA, MD
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:
1568402360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4712 DEXTER DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-758-2600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4712 DEXTER DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-758-2600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUPTA
Authorized Official First Name:
NARESH
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MANAGING PARTNER OWNER
Authorized Official Telephone Number:
972-758-2600

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  K4073 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 142408701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0083EZ . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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