Provider Demographics
NPI:1568655504
Name:THE REGIONAL CANCER CENTER
Entity Type:Organization
Organization Name:THE REGIONAL CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KANDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-838-9000
Mailing Address - Street 1:2500 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4508
Mailing Address - Country:US
Mailing Address - Phone:814-838-9000
Mailing Address - Fax:
Practice Address - Street 1:2500 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4508
Practice Address - Country:US
Practice Address - Phone:814-838-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE REGIONAL CANCER CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABR16277683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007470530003Medicaid