Provider Demographics
NPI:1568402360
Name:ONCOLOGY CENTER OF THE SOUTHWEST, PA
Entity Type:Organization
Organization Name:ONCOLOGY CENTER OF THE SOUTHWEST, PA
Other - Org Name:NARESH GUPTA, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING PARTNER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NARESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-758-2600
Mailing Address - Street 1:4712 DEXTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-758-2600
Mailing Address - Fax:
Practice Address - Street 1:4712 DEXTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-758-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4073207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142408701Medicaid
TX0083EZOtherBC/BS
TX142408701Medicaid
TX900002261Medicare PIN
TX00166RMedicare PIN