Provider Demographics
NPI:1972648285
Name:ASHLAND RADIATION ONCOLOGY, PSC
Entity Type:Organization
Organization Name:ASHLAND RADIATION ONCOLOGY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-329-0060
Mailing Address - Street 1:706 23RD ST
Mailing Address - Street 2:TRI-STATE REGIONAL CANCER CENTER
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2832
Mailing Address - Country:US
Mailing Address - Phone:606-329-0060
Mailing Address - Fax:606-325-9366
Practice Address - Street 1:706 23RD ST
Practice Address - Street 2:TRI-STATE REGIONAL CANCER CENTER
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2832
Practice Address - Country:US
Practice Address - Phone:606-329-0060
Practice Address - Fax:606-325-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004701Medicaid
KY65919201Medicaid
14024Medicare PIN