Provider Demographics
NPI:1891086096
Name:RADIATION THERAPY ASSOCIATES OF WESTERN NORTH CAROLINA, PA
Entity Type:Organization
Organization Name:RADIATION THERAPY ASSOCIATES OF WESTERN NORTH CAROLINA, PA
Other - Org Name:FOOTHILLS UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-456-2690
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:141 TRYON RD
Practice Address - Street 2:SUITE B
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-3099
Practice Address - Country:US
Practice Address - Phone:828-286-1445
Practice Address - Fax:828-286-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2019-07-19
Deactivation Date:2019-07-11
Deactivation Code:
Reactivation Date:2019-07-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty