Provider Demographics
NPI:1194824862
Name:BLANCHARD VALLEY REGIONAL CANCER CENTER LLC
Entity Type:Organization
Organization Name:BLANCHARD VALLEY REGIONAL CANCER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:CYTLAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-423-5497
Mailing Address - Street 1:PO BOX 636320
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6320
Mailing Address - Country:US
Mailing Address - Phone:419-429-6499
Mailing Address - Fax:419-429-6494
Practice Address - Street 1:15990 MEDICAL DR S
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-8894
Practice Address - Country:US
Practice Address - Phone:419-423-3703
Practice Address - Fax:419-427-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084779Medicaid
OHP00349396OtherRAILROAD CARE
OH9355701Medicare PIN