Provider Demographics
NPI:1700963501
Name:ONCOLOGY AND HEMATOLOGY CENTER, P.C.
Entity Type:Organization
Organization Name:ONCOLOGY AND HEMATOLOGY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDWINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-782-7722
Mailing Address - Street 1:PO BOX 2786
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2786
Mailing Address - Country:US
Mailing Address - Phone:417-782-7722
Mailing Address - Fax:417-782-4547
Practice Address - Street 1:2727 MCCLELLAND BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1626
Practice Address - Country:US
Practice Address - Phone:417-782-7722
Practice Address - Fax:417-782-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO503417008Medicaid
MO503417008Medicaid