Provider Demographics
NPI:1457463523
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:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-759-7039
Mailing Address - Street 1:PO BOX 3089
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47730-3089
Mailing Address - Country:US
Mailing Address - Phone:812-471-1200
Mailing Address - Fax:812-475-6700
Practice Address - Street 1:3699 EPWORTH RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8909
Practice Address - Country:US
Practice Address - Phone:812-471-1200
Practice Address - Fax:812-475-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty