Provider Demographics
NPI:1629044839
Name:MEDICAL ONCOLOGY INC
Entity Type:Organization
Organization Name:MEDICAL ONCOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MTANIUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SULTANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-627-7163
Mailing Address - Street 1:PO BOX 1887
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614
Mailing Address - Country:US
Mailing Address - Phone:662-627-7163
Mailing Address - Fax:662-627-7150
Practice Address - Street 1:581 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614
Practice Address - Country:US
Practice Address - Phone:662-627-7163
Practice Address - Fax:662-627-7150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL ONCOLOGY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-27
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty