Provider Demographics
NPI:1245289859
Name:HEMATOLOGY & ONCOLOGY CENTER, PLLC
Entity type:Organization
Organization Name:HEMATOLOGY & ONCOLOGY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:N
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-676-0275
Mailing Address - Street 1:401 BOGLE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2849
Mailing Address - Country:US
Mailing Address - Phone:606-676-0275
Mailing Address - Fax:606-676-0295
Practice Address - Street 1:401 BOGLE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2849
Practice Address - Country:US
Practice Address - Phone:606-676-0275
Practice Address - Fax:606-676-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYG83986Medicare UPIN
KY1851373096OtherNPI INDIVIDUAL
KY00008Medicare ID - Type UnspecifiedMEDICARE KY
KY64087000Medicaid