Provider Demographics
NPI:1164513339
Name:RADIATION ONCOLOGY PSC
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:STAELENA
Authorized Official - Last Name:BRIONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-926-7228
Mailing Address - Street 1:1000 BRECKENRIDGE STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-0876
Mailing Address - Country:US
Mailing Address - Phone:270-926-7228
Mailing Address - Fax:270-926-6559
Practice Address - Street 1:1000 BRECKENRIDGE STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0876
Practice Address - Country:US
Practice Address - Phone:270-926-7228
Practice Address - Fax:270-926-6559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY173182085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65907636Medicaid
KY000000040652OtherANTHEM
KY50003514OtherPASSPORT HEALTH PLAN
KY260109OtherBLACK LUNG
KYRO 1278131OtherUMWA HEALTH & RETIREMENT
KY000000040652OtherANTHEM
KYA13948Medicare UPIN
KYCA8914Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KY65907636Medicaid