Provider Demographics
NPI:1891335873
Name:CENTRAL CARE, PA
Entity Type:Organization
Organization Name:CENTRAL CARE, PA
Other - Org Name:CENTRAL CARE CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-823-0633
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-0256
Mailing Address - Country:US
Mailing Address - Phone:785-823-0633
Mailing Address - Fax:844-854-4662
Practice Address - Street 1:8929 PARALLEL PKWY STE G
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1689
Practice Address - Country:US
Practice Address - Phone:913-318-7821
Practice Address - Fax:833-834-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty