Provider Demographics
NPI:1477546984
Name:SPRINGFIELD REGIONAL CANCER CENTER, LLC
Entity Type:Organization
Organization Name:SPRINGFIELD REGIONAL CANCER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNTAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-323-5001
Mailing Address - Street 1:148 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2547
Mailing Address - Country:US
Mailing Address - Phone:937-323-5001
Mailing Address - Fax:937-323-5413
Practice Address - Street 1:148 W NORTH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2547
Practice Address - Country:US
Practice Address - Phone:937-323-5001
Practice Address - Fax:937-323-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1097RT2471R0002X
261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
No2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2516361Medicaid
OH2468517OtherUHC PROVIDER #
OH000000339942OtherANTHEM BC/BS PROVIDER #
OH7378615OtherAETNA PROVIDER #
OH2516361Medicaid
OH000000339942OtherANTHEM BC/BS PROVIDER #
OH2516361Medicaid
OH7378615OtherAETNA PROVIDER #