Provider Demographics
NPI:1922057850
Name:HENDERSON CANCER CENTER PSC
Entity Type:Organization
Organization Name:HENDERSON CANCER CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:KORBA
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:270-826-0255
Mailing Address - Street 1:PO BOX 15040
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-0040
Mailing Address - Country:US
Mailing Address - Phone:812-476-1367
Mailing Address - Fax:812-477-4153
Practice Address - Street 1:1401 N ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2784
Practice Address - Country:US
Practice Address - Phone:270-827-0255
Practice Address - Fax:270-826-5342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCA0138OtherRR MEDICARE
KY65913774Medicaid
KYCA0138OtherRR MEDICARE