Provider Demographics
NPI:1578885406
Name:JOHNSTON RADIATION ONCOLOGY LLC
Entity Type:Organization
Organization Name:JOHNSTON RADIATION ONCOLOGY LLC
Other - Org Name:UNC RADIATION ONCOLOGY AT CLAYTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CIELINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-938-6629
Mailing Address - Street 1:2076 HWY 42 W
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5303
Mailing Address - Country:US
Mailing Address - Phone:919-585-8550
Mailing Address - Fax:
Practice Address - Street 1:2076 HWY 42 W
Practice Address - Street 2:SUITE 120
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5303
Practice Address - Country:US
Practice Address - Phone:919-585-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JRH VENTURES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, RadiationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914186Medicaid
NC5914186Medicaid