Provider Demographics
NPI:1285687178
Name:COMMONWEALTH HEMATOLOGY ONCOLOGY PSC
Entity Type:Organization
Organization Name:COMMONWEALTH HEMATOLOGY ONCOLOGY PSC
Other - Org Name:COMMONWEALTH CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BACHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-677-1451
Mailing Address - Street 1:520 TECHWOOD DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8500
Mailing Address - Country:US
Mailing Address - Phone:859-936-9844
Mailing Address - Fax:859-236-0320
Practice Address - Street 1:520 TECHWOOD DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-8500
Practice Address - Country:US
Practice Address - Phone:859-936-9844
Practice Address - Fax:859-236-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78903879Medicaid
KY000000060792OtherANTHEM
KY2435612000OtherPASSPORT ADVANTAGE
KY6593160Medicaid
KY1083462OtherPASSPORT HEALTH CARE
KYCA8281OtherRAILROAD MEDICARE
KY=========OtherAETNA
KY=========OtherHUMUNA
KY1083462OtherPASSPORT HEALTH CARE
KY5464Medicare PIN
KY5102Medicare PIN
KY0120Medicare PIN
KY8726Medicare PIN
KY5101Medicare PIN