Provider Demographics
NPI:1922425891
Name:REGIONAL MEDICAL ONCOLOGY CENTER
Entity Type:Organization
Organization Name:REGIONAL MEDICAL ONCOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-991-5261
Mailing Address - Street 1:2624 ORTHO DR W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3484
Mailing Address - Country:US
Mailing Address - Phone:252-991-5261
Mailing Address - Fax:252-991-5262
Practice Address - Street 1:2624 ORTHO DR
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-991-5261
Practice Address - Fax:252-991-5262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC193200000X183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6901720001OtherDMERC PTAN