Provider Demographics
NPI:1437361516
Name:ONCOLOGY HEMATOLOGY ASSOCIATES OF SOUTHWEST INDIANA
Entity Type:Organization
Organization Name:ONCOLOGY HEMATOLOGY ASSOCIATES OF SOUTHWEST INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-962-0771
Mailing Address - Street 1:3801 BELLEMEADE SUITE 110
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:NE
Mailing Address - Zip Code:47714
Mailing Address - Country:US
Mailing Address - Phone:812-962-0771
Mailing Address - Fax:812-962-0777
Practice Address - Street 1:3801 BELLEMEADE SUITE 110
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714
Practice Address - Country:US
Practice Address - Phone:812-471-1200
Practice Address - Fax:812-962-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN64019102Medicaid
IN64291792Medicaid
IN64877483Medicaid
IN64045180Medicaid
IN64880560Medicaid
IN64061286Medicaid
IN64879513Medicaid