Provider Demographics
NPI:1063485639
Name:ONCOLOGY & HEMATOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ONCOLOGY & HEMATOLOGY ASSOCIATES, LLC
Other - Org Name:CENTRAL INDIANA CANCER CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREENSPAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-594-6900
Mailing Address - Street 1:250 N. SHADELAND AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-962-4792
Mailing Address - Fax:317-962-4391
Practice Address - Street 1:6845 RAMA DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1707
Practice Address - Country:US
Practice Address - Phone:317-964-5200
Practice Address - Fax:317-964-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100058170Medicaid
IN100058170Medicaid
0765130002Medicare NSC