Provider Demographics
NPI:1831576834
Name:ONCORDIS CLINIC AT CANCER TREATMENT CENTERS OF AMERICA PC
Entity type:Organization
Organization Name:ONCORDIS CLINIC AT CANCER TREATMENT CENTERS OF AMERICA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:HALDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-286-5502
Mailing Address - Street 1:PO BOX 33069
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74153-1069
Mailing Address - Country:US
Mailing Address - Phone:918-286-5502
Mailing Address - Fax:
Practice Address - Street 1:10153 EAST 79TH STREET
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-286-5502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology