Provider Demographics
NPI:1669424958
Name:RADIATION ONCOLOGY SERVICES OF DUBUQUE PC
Entity type:Organization
Organization Name:RADIATION ONCOLOGY SERVICES OF DUBUQUE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:GATES
Authorized Official - Last Name:LALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-556-2097
Mailing Address - Street 1:120 BRYANT ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7403
Mailing Address - Country:US
Mailing Address - Phone:563-556-2097
Mailing Address - Fax:563-556-1570
Practice Address - Street 1:350 N GRANDVIEW AVE
Practice Address - Street 2:WENDT CANCER CENTER
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6388
Practice Address - Country:US
Practice Address - Phone:563-589-2468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA524382085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA0100OtherJOHN DEERE HEALTH PLANS
WI32883000Medicaid
IA0002154Medicaid
WI547180OtherDEAN HEALTH PLANS
WI547180OtherDEAN HEALTH PLANS
WI=========OtherUNITY HEALTH INSURANCE
IAIA0100OtherJOHN DEERE HEALTH PLANS
WI32883000Medicaid