Provider Demographics
NPI:1912115528
Name:NATCHEZ ONCOLOGY CENTER
Entity Type:Organization
Organization Name:NATCHEZ ONCOLOGY CENTER
Other - Org Name:CARING RIVER CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAPPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-442-1285
Mailing Address - Street 1:PO BOX 18699
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39122-8699
Mailing Address - Country:US
Mailing Address - Phone:601-442-1285
Mailing Address - Fax:601-446-9683
Practice Address - Street 1:133 JEFFERSON DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5103
Practice Address - Country:US
Practice Address - Phone:601-442-1285
Practice Address - Fax:601-446-9683
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOBILE DIAGNOSTICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-18
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4453174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014045Medicaid
MSC02053Medicare ID - Type Unspecified