Provider Demographics
NPI:1346313186
Name:NORFOLK ONCOLOGY CONSULTANTS, PC
Entity Type:Organization
Organization Name:NORFOLK ONCOLOGY CONSULTANTS, PC
Other - Org Name:HEMATOLOGY & ONCOLOGY CONSULTANTS, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYNNE
Authorized Official - Middle Name:RENEA
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-572-3529
Mailing Address - Street 1:PO BOX 641850
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7850
Mailing Address - Country:US
Mailing Address - Phone:402-572-3529
Mailing Address - Fax:402-572-2892
Practice Address - Street 1:110 N 29TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4461
Practice Address - Country:US
Practice Address - Phone:402-644-7550
Practice Address - Fax:402-644-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20876207RH0003X
NE21140207RH0003X
NE15291207RH0003X
NE13385207RH0003X
NE22157207RH0003X
NE17561207RH0003X, 2085R0001X
NE110233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NECI2142OtherRAILROAD MEDICARE
NECI2142OtherRAILROAD MEDICARE
P99227Medicare UPIN
NE=========13Medicaid
B67791Medicare UPIN
NECI2142OtherRAILROAD MEDICARE
G99720Medicare UPIN
NE087350Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
E20896Medicare UPIN
G74737Medicare UPIN