Provider Demographics
NPI:1982778239
Name:REGIONAL ONCOLOGY, LLC
Entity Type:Organization
Organization Name:REGIONAL ONCOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-320-8780
Mailing Address - Street 1:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-0590
Mailing Address - Country:US
Mailing Address - Phone:706-320-8720
Mailing Address - Fax:
Practice Address - Street 1:1831 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8915
Practice Address - Country:US
Practice Address - Phone:706-320-8720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDTOWN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529912330Medicaid
GA300035417BMedicaid
=========31901B001OtherTRICARE WPS
GA300035417BMedicaid
GAGRP4053Medicare PIN