Provider Demographics
NPI:1831272889
Name:COMPREHENSIVE CANCER CENTER OF OKLAHOMA PC
Entity type:Organization
Organization Name:COMPREHENSIVE CANCER CENTER OF OKLAHOMA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-942-9200
Mailing Address - Street 1:3525 NW 56TH ST
Mailing Address - Street 2:SUITE D-100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4550
Mailing Address - Country:US
Mailing Address - Phone:405-942-9200
Mailing Address - Fax:405-942-9219
Practice Address - Street 1:3525 NW 56TH ST
Practice Address - Street 2:SUITE D-100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4550
Practice Address - Country:US
Practice Address - Phone:405-942-9200
Practice Address - Fax:405-942-9219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200042510AMedicaid
OK400522293Medicare UPIN
OK5373300001Medicare NSC