1225010234 NPI number — CENTRIC RADIATION ONCOLOGY PC

Table of content: (NPI 1225010234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225010234 NPI number — CENTRIC RADIATION ONCOLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRIC RADIATION ONCOLOGY PC
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:
1225010234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30560
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90030-0560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-335-4000
Provider Business Mailing Address Fax Number:
310-335-4098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
470 JOHN YOUNG WAY
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
EXTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-524-5550
Provider Business Practice Location Address Fax Number:
610-524-5546
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
YELOVICH
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
610-524-5550

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: 084362 . This is a "BCBS PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0121427000 . This is a "KEYSTONE 65" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0121427000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016763100002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016763100003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CG2734 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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