Provider Demographics
NPI:1154301539
Name:KIGGUNDU RADIATION THERAPY, PA
Entity Type:Organization
Organization Name:KIGGUNDU RADIATION THERAPY, PA
Other - Org Name:KIGGUNDU RADIATION THERAPY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:KIGGUNDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-262-8800
Mailing Address - Street 1:1419 SE 8TH TER STE 200
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3213
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2000 FOUNDATION WAY
Practice Address - Street 2:SUITE 1100
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9003
Practice Address - Country:US
Practice Address - Phone:304-262-8800
Practice Address - Fax:304-262-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003414Medicaid
WVKA9356461Medicare ID - Type Unspecified