Provider Demographics
NPI:1528399524
Name:RADIATION ONCOLOGY OF NORTH MS PLLC
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY OF NORTH MS PLLC
Other - Org Name:CANCER CARE CENTER OF STARKVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-620-7102
Mailing Address - Street 1:620 CROSSOVER RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4944
Mailing Address - Country:US
Mailing Address - Phone:662-620-7102
Mailing Address - Fax:662-620-7106
Practice Address - Street 1:1207 HIGHWAY 182 W
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9820
Practice Address - Country:US
Practice Address - Phone:662-320-7788
Practice Address - Fax:662-320-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05478792Medicaid