1376571927 NPI number — OAKTREE CANCER CARE INC

Table of content: (NPI 1376571927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376571927 NPI number — OAKTREE CANCER CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKTREE CANCER CARE INC
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:
1376571927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1093
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEMONT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16851-1093
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:
1145 BOWER HILL RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15243-1342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-279-3694
Provider Business Practice Location Address Fax Number:
412-279-3678
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GALLO
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
412-781-7070

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: 0018540820001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2232006 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com