Provider Demographics
NPI:1962464586
Name:RADIATION ONCOLOGY ASSOCIATES MEDICAL GROUP, INC. DBA. ONCOLOGY CARE P
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY ASSOCIATES MEDICAL GROUP, INC. DBA. ONCOLOGY CARE P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:L
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-447-4050
Mailing Address - Street 1:PO BOX 28911
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8911
Mailing Address - Country:US
Mailing Address - Phone:559-228-4200
Mailing Address - Fax:
Practice Address - Street 1:7257 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2950
Practice Address - Country:US
Practice Address - Phone:559-447-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG454872085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13437ZMedicare ID - Type UnspecifiedFACILITY ID