1275679920 NPI number — PERMIAN RADIATION ONCOLOGY

Table of content: (NPI 1275679920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275679920 NPI number — PERMIAN RADIATION ONCOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERMIAN 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:
6
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:
1275679920
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 3776
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44513-3776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-788-7137
Provider Business Mailing Address Fax Number:
330-788-8871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 GYPSY LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44501-0240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-884-4400
Provider Business Practice Location Address Fax Number:
330-788-8871
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SVENSON
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-788-7137

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  35 05 3495 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0687163 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com