Provider Demographics
NPI:1740590397
Name:SKPR OH 1 LLC
Entity Type:Organization
Organization Name:SKPR OH 1 LLC
Other - Org Name:SCIOTO COUNTY CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-386-0000
Mailing Address - Street 1:285 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SEAMAN
Mailing Address - State:OH
Mailing Address - Zip Code:45679-8006
Mailing Address - Country:US
Mailing Address - Phone:937-386-0000
Mailing Address - Fax:937-386-0009
Practice Address - Street 1:915 10TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4152
Practice Address - Country:US
Practice Address - Phone:937-386-0000
Practice Address - Fax:937-386-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053209261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3100389Medicaid
OH9392871Medicare PIN