Provider Demographics
NPI:1114050556
Name:COMMUNITY HOSPTIAL ANDERSON MEDICAL ONCOLOGY
Entity Type:Organization
Organization Name:COMMUNITY HOSPTIAL ANDERSON MEDICAL ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAHIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAQVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-298-1621
Mailing Address - Street 1:PO BOX 68952
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-0952
Mailing Address - Country:US
Mailing Address - Phone:317-802-3153
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:1340 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-1216
Practice Address - Country:US
Practice Address - Phone:765-298-1621
Practice Address - Fax:765-298-4942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059601261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200492290Medicaid
IN200492290Medicaid
236880Medicare PIN