Provider Demographics
NPI:1588621312
Name:WEST CENTRAL OH CANCER CARE, INC.
Entity Type:Organization
Organization Name:WEST CENTRAL OH CANCER CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:RENA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-996-5063
Mailing Address - Street 1:PO BOX 26706
Mailing Address - Street 2:SECTION 95
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0706
Mailing Address - Country:US
Mailing Address - Phone:419-996-5612
Mailing Address - Fax:
Practice Address - Street 1:803 W MARKET
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805
Practice Address - Country:US
Practice Address - Phone:419-996-5063
Practice Address - Fax:419-996-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053193Z2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2141597Medicaid
OH2141597Medicaid