Provider Demographics
NPI:1023001237
Name:SOUTHWEST RADIATION ONCOLOGY, INC
Entity Type:Organization
Organization Name:SOUTHWEST RADIATION ONCOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEDBERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-329-2389
Mailing Address - Street 1:PO BOX 1072
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1072
Mailing Address - Country:US
Mailing Address - Phone:405-329-2389
Mailing Address - Fax:405-321-0326
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:405-329-2389
Practice Address - Fax:405-321-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK168402085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty