Provider Demographics
NPI:1003905266
Name:RADIATION ONCOLOGY OF MISSISSIPPI PA
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY OF MISSISSIPPI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZACHOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-376-2074
Mailing Address - Street 1:970 LAKELAND DR
Mailing Address - Street 2:SUITE 34
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4635
Mailing Address - Country:US
Mailing Address - Phone:601-362-0600
Mailing Address - Fax:601-362-1186
Practice Address - Street 1:970 LAKELAND DR
Practice Address - Street 2:SUITE 34
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4635
Practice Address - Country:US
Practice Address - Phone:601-362-0600
Practice Address - Fax:601-362-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09012235Medicaid
MS009012235Medicaid
MS91-066530OtherBLUE CROSS ACH
MS91-066530OtherBLUE CROSS ACH