Provider Demographics
NPI:1477943819
Name:ONCOLOGY HEMATOLOGY ASSOCIATES OF CENTRAL IL, PC
Entity Type:Organization
Organization Name:ONCOLOGY HEMATOLOGY ASSOCIATES OF CENTRAL IL, PC
Other - Org Name:ILLINOIS CANCER CAER PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-243-3405
Mailing Address - Street 1:336 HOME BLVD
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-7408
Mailing Address - Country:US
Mailing Address - Phone:309-243-3017
Mailing Address - Fax:309-343-2084
Practice Address - Street 1:336 HOME BLVD
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-7408
Practice Address - Country:US
Practice Address - Phone:309-243-3017
Practice Address - Fax:309-343-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.0186903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149797OtherPK