Provider Demographics
NPI:1780712158
Name:RADIATION ONCOLOGY GROUP, PC
Entity type:Organization
Organization Name:RADIATION ONCOLOGY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-889-2400
Mailing Address - Street 1:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16603
Mailing Address - Country:US
Mailing Address - Phone:814-889-2400
Mailing Address - Fax:814-889-2048
Practice Address - Street 1:620 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4804
Practice Address - Country:US
Practice Address - Phone:814-889-2400
Practice Address - Fax:814-889-2048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008766200004Medicaid
PA0008766200004Medicaid