Provider Demographics
NPI:1477533347
Name:OZARK RADIATION ONCOLOGY
Entity Type:Organization
Organization Name:OZARK RADIATION ONCOLOGY
Other - Org Name:NORTHWEST ARKANSAS RADIATION ONCOLOGY ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITELEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:479-751-0602
Mailing Address - Street 1:PO BOX 8428
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0008
Mailing Address - Country:US
Mailing Address - Phone:479-751-0602
Mailing Address - Fax:479-361-6201
Practice Address - Street 1:60 E MONTE PAINTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-361-2585
Practice Address - Fax:479-361-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B079Medicare ID - Type Unspecified