Provider Demographics
NPI:1093047185
Name:TERRY D POWELL RADIATION ONCOLOGIST, INC.
Entity Type:Organization
Organization Name:TERRY D POWELL RADIATION ONCOLOGIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-252-1684
Mailing Address - Street 1:PO BOX 993
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-0993
Mailing Address - Country:US
Mailing Address - Phone:620-252-1684
Mailing Address - Fax:620-252-1692
Practice Address - Street 1:1400 W 4TH ST,
Practice Address - Street 2:RADIATION ONCOLOGY DEPT
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337
Practice Address - Country:US
Practice Address - Phone:620-252-1684
Practice Address - Fax:620-252-1692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-142322085R0203X
OK91062085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100200170BMedicaid
KS100196610BMedicaid
OK100200170BMedicaid
KS100196610BMedicaid