Provider Demographics
NPI:1508812140
Name:ONCOLOGY ASSOCIATES INC PSC
Entity Type:Organization
Organization Name:ONCOLOGY ASSOCIATES INC PSC
Other - Org Name:ONCOLOGY ASSOCIATES OF WEST KY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:REIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-444-3930
Mailing Address - Street 1:PO BOX 8449
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-8449
Mailing Address - Country:US
Mailing Address - Phone:270-444-3930
Mailing Address - Fax:270-442-5284
Practice Address - Street 1:2603 KENTUCKY AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3814
Practice Address - Country:US
Practice Address - Phone:270-444-3930
Practice Address - Fax:270-442-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCI1416OtherRAILROAD MEDICARE
KY65930497Medicaid
KYCI1416OtherRAILROAD MEDICARE