Provider Demographics
NPI:1043371057
Name:VIRGINIA RADIATION THERAPY AND ONCOLOGY
Entity Type:Organization
Organization Name:VIRGINIA RADIATION THERAPY AND ONCOLOGY
Other - Org Name:MID RIVERS CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-493-8880
Mailing Address - Street 1:PO BOX 8510
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-8510
Mailing Address - Country:US
Mailing Address - Phone:804-493-8880
Mailing Address - Fax:804-493-9993
Practice Address - Street 1:15394 KINGS HWY
Practice Address - Street 2:
Practice Address - City:MONTROSS
Practice Address - State:VA
Practice Address - Zip Code:22520-2746
Practice Address - Country:US
Practice Address - Phone:804-493-8880
Practice Address - Fax:804-493-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010441012085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA503970OtherNCPPO
VACL1681OtherMEDICARE RAILROAD
VA211132OtherANTHEM BLUE CROSS VA
VA211132OtherANTHEM BLUE CROSS VA
VAC05533Medicare PIN