Provider Demographics
NPI:1700152212
Name:EPLUS ONCOLOGICS MISSISSIPPI, LLC
Entity Type:Organization
Organization Name:EPLUS ONCOLOGICS MISSISSIPPI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCOO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RHYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-467-7400
Mailing Address - Street 1:917 GENERAL MOUTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-8511
Mailing Address - Country:US
Mailing Address - Phone:337-237-2057
Mailing Address - Fax:337-264-1029
Practice Address - Street 1:127 SOUTH 13TH STREET
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4111
Practice Address - Country:US
Practice Address - Phone:601-425-2999
Practice Address - Fax:615-467-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013614Medicaid
MS09013614Medicaid