1952368771 NPI number — CENTRAL KANSAS RADIATION ONCOLOGY, PA

Table of content: JEREMY PAUL CATRON LCSW (NPI 1962479675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952368771 NPI number — CENTRAL KANSAS RADIATION ONCOLOGY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL KANSAS RADIATION ONCOLOGY, 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:
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:
1952368771
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 26706
Provider Second Line Business Mailing Address:
SECTION #106
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73126-0706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
817 N EMPORIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67214-3709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-268-5980
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAN
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
C-S
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
316-268-5980

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  0422757 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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