Provider Demographics
NPI:1922097047
Name:CHILDRENS HEMATOLOGY & ONCOLOGY ASSOCIATES P A
Entity Type:Organization
Organization Name:CHILDRENS HEMATOLOGY & ONCOLOGY ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:STUMBO-OSHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-844-6363
Mailing Address - Street 1:5325 GREENWOOD AVE
Mailing Address - Street 2:#306
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2452
Mailing Address - Country:US
Mailing Address - Phone:561-844-6363
Mailing Address - Fax:561-844-6391
Practice Address - Street 1:5325 GREENWOOD AVE
Practice Address - Street 2:#306
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2452
Practice Address - Country:US
Practice Address - Phone:561-844-6363
Practice Address - Fax:561-844-6391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME512892080P0207X
FL800004117291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257718600Medicaid
FL38635OtherBLUE CROSS/BLUE SHIELD FL
FL38635OtherBLUE CROSS/BLUE SHIELD FL
FL047414200Medicare ID - Type Unspecified