Provider Demographics
NPI:1629145719
Name:NATCHEZ ONCOLOGY CLINIC INCORPORATED
Entity Type:Organization
Organization Name:NATCHEZ ONCOLOGY CLINIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-442-9210
Mailing Address - Street 1:400 S COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3506
Mailing Address - Country:US
Mailing Address - Phone:601-442-9210
Mailing Address - Fax:601-442-7409
Practice Address - Street 1:106 JEFFERSON DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5104
Practice Address - Country:US
Practice Address - Phone:601-442-9210
Practice Address - Fax:601-442-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15252207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123444Medicaid
MS09015568Medicaid
G55249Medicare UPIN
900003448Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
MS00123444Medicaid