Provider Demographics
NPI:1083651327
Name:PRECISION RADIATION ONCOLOGY SYSTEMS
Entity Type:Organization
Organization Name:PRECISION RADIATION ONCOLOGY SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCLAURIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:919-497-0113
Mailing Address - Street 1:8741 LANDMARK RD
Mailing Address - Street 2:C/O MICHELLE TRAINHAM
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2801
Mailing Address - Country:US
Mailing Address - Phone:804-264-7605
Mailing Address - Fax:804-672-6899
Practice Address - Street 1:113 JOLLY ST
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549
Practice Address - Country:US
Practice Address - Phone:919-497-0113
Practice Address - Fax:919-497-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
188301OtherMEDCOST
NC5902794Medicaid
NC017WNOtherBCBS
=========OtherUNITED HEALTHCARE
=========OtherTRICARE
188301OtherMEDCOST
NC017WNOtherBCBS
NCDR4926Medicare PIN