Provider Demographics
NPI:1225274244
Name:TRI-STATE RADIATION ONCOLOGY CENTERS LLC
Entity Type:Organization
Organization Name:TRI-STATE RADIATION ONCOLOGY CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-335-4000
Mailing Address - Street 1:PO BOX 2084
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2084
Mailing Address - Country:US
Mailing Address - Phone:800-331-9294
Mailing Address - Fax:812-471-9282
Practice Address - Street 1:700 N BURKHARDT RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2740
Practice Address - Country:US
Practice Address - Phone:812-474-1110
Practice Address - Fax:812-474-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDP0313OtherRR MEDICARE
IN200926120BMedicaid
IN200926120AMedicaid
IN259540Medicare PIN