Provider Demographics
NPI:1336147990
Name:THE REGIONAL CANCER CENTER
Entity Type:Organization
Organization Name:THE REGIONAL CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-836-2604
Mailing Address - Street 1:2500 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505
Mailing Address - Country:US
Mailing Address - Phone:814-836-2651
Mailing Address - Fax:814-838-0443
Practice Address - Street 1:2500 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505
Practice Address - Country:US
Practice Address - Phone:814-836-2651
Practice Address - Fax:814-838-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RX0202X, 2085R0001X
PA207RX0202X, 2085R0001X
PABR16277683336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No3336C0002XSuppliersPharmacyClinic PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017638630005Medicaid
PA3956945OtherNCPDP
PA105863OtherUPMC
127683OtherMED PLUSH
PA991590OtherB CROSS
PACI0349Medicare PIN
PA991590OtherB CROSS
PA140052Medicare PIN
PA105863OtherUPMC
OH9360591Medicare PIN