Provider Demographics
NPI:1164833307
Name:ONCOLOGY HEMATOLOGY WEST, PC
Entity Type:Organization
Organization Name:ONCOLOGY HEMATOLOGY WEST, PC
Other - Org Name:NCS OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-334-4773
Mailing Address - Street 1:17201 WRIGHT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17201 WRIGHT ST STE 204
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2042
Practice Address - Country:US
Practice Address - Phone:402-691-1502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100264399-00Medicaid
NE7211750001Medicare NSC