Provider Demographics
NPI:1891920948
Name:METROHEALTH RADIATION ONCOLOGY GROUP, INC.
Entity Type:Organization
Organization Name:METROHEALTH RADIATION ONCOLOGY GROUP, INC.
Other - Org Name:RADIATION THERAPY AND CANCER INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HERIBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-774-5555
Mailing Address - Street 1:PO BOX 191625
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1625
Mailing Address - Country:US
Mailing Address - Phone:787-774-5555
Mailing Address - Fax:
Practice Address - Street 1:410 CARR 2
Practice Address - Street 2:BO. SABALOS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1560
Practice Address - Country:US
Practice Address - Phone:787-652-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20931OtherMEDICARE
PR20271OtherMEDICARE
PR85063OtherMEDICARE