Provider Demographics
NPI:1346298551
Name:MIDWEST ONCOLOGY GROUP, PLLC
Entity Type:Organization
Organization Name:MIDWEST ONCOLOGY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR-GROUP
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-737-8455
Mailing Address - Street 1:PO BOX 26525
Mailing Address - Street 2:DEPT 1
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0525
Mailing Address - Country:US
Mailing Address - Phone:405-843-5855
Mailing Address - Fax:405-843-5865
Practice Address - Street 1:230 N MIDWEST BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4321
Practice Address - Country:US
Practice Address - Phone:405-737-8455
Practice Address - Fax:405-739-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18028261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200001200AMedicaid
OKCK5601Medicare PIN
OK200001200AMedicaid