Provider Demographics
NPI:1932139607
Name:CANCER NETWORK OF WEST CENTRAL OHIO
Entity Type:Organization
Organization Name:CANCER NETWORK OF WEST CENTRAL OHIO
Other - Org Name:HIGH POINT REGIONAL CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING EXECUTIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PROVAZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-226-9103
Mailing Address - Street 1:900 HAVEMANN ROAD
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-1870
Mailing Address - Country:US
Mailing Address - Phone:419-584-1900
Mailing Address - Fax:
Practice Address - Street 1:2160 EWING CRAWFIS CIRCLE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9042
Practice Address - Country:US
Practice Address - Phone:937-592-9221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CANCER NETWORK OF WEST CENTRAL OHIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1056RT261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2429849Medicaid
TH9341182Medicare Oscar/Certification