Provider Demographics
NPI:1205862927
Name:EASTERN WOODS RADIATION ONCOLOGY
Entity type:Organization
Organization Name:EASTERN WOODS RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-423-3703
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43697-0330
Mailing Address - Country:US
Mailing Address - Phone:614-430-5712
Mailing Address - Fax:
Practice Address - Street 1:15990 MEDICAL DR S
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-8894
Practice Address - Country:US
Practice Address - Phone:419-423-4500
Practice Address - Fax:419-427-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2401921Medicaid
DA1414OtherMEDICARE RAILROAD
DA1414OtherMEDICARE RAILROAD