Provider Demographics
NPI:1023020948
Name:HEMATOLOGY ONCOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:HEMATOLOGY ONCOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:731-234-2425
Mailing Address - Street 1:PO BOX 11076
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38308-0117
Mailing Address - Country:US
Mailing Address - Phone:731-868-4441
Mailing Address - Fax:731-410-6824
Practice Address - Street 1:367 HOSPITAL BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2080
Practice Address - Country:US
Practice Address - Phone:731-234-2425
Practice Address - Fax:731-410-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29190261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734537Medicaid
TN3734537Medicaid
TN3734537Medicaid