Provider Demographics
NPI:1114018470
Name:SPARTANBURG RADIATION ONCOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:SPARTANBURG RADIATION ONCOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOSEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:864-560-6917
Mailing Address - Street 1:75 REMITTANCE DR
Mailing Address - Street 2:STE 6588
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 EAST WOOD STREET
Practice Address - Street 2:RADIATION ONCOLOGY
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6917
Practice Address - Fax:864-560-6014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890124VMedicaid
SCGP0371Medicaid
SC3985Medicare PIN