Provider Demographics
NPI:1649379553
Name:RADIATION THERAPY ASSOCIATES PC
Entity Type:Organization
Organization Name:RADIATION THERAPY ASSOCIATES PC
Other - Org Name:CLEVELAND REGIONAL CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:VIROSTEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-472-2171
Mailing Address - Street 1:2620 PEERLESS RD NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3732
Mailing Address - Country:US
Mailing Address - Phone:423-472-2171
Mailing Address - Fax:423-472-0060
Practice Address - Street 1:2620 PEERLESS RD NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3732
Practice Address - Country:US
Practice Address - Phone:423-472-2171
Practice Address - Fax:423-472-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA0602A2261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3383564Medicaid
TN3383564Medicaid
TN103I929502Medicare PIN