Provider Demographics
NPI:1013315076
Name:CLERMONT COUNTY CANCER CENTER LLC
Entity Type:Organization
Organization Name:CLERMONT COUNTY CANCER CENTER LLC
Other - Org Name:CLERMONT COUNTY CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAYAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-735-4442
Mailing Address - Street 1:4402 HARTMAN LN
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1971
Mailing Address - Country:US
Mailing Address - Phone:513-735-4442
Mailing Address - Fax:513-735-4443
Practice Address - Street 1:4402 HARTMAN LN
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1971
Practice Address - Country:US
Practice Address - Phone:513-735-4442
Practice Address - Fax:513-735-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty