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NPI Code Detail

MEDICARE: PRIMARY ONCOLOGY NETWORK PLLC

MEDICARE: PRIMARY ONCOLOGY NETWORK PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory17192WV
2332900000XNon-Pharmacy Dispensing Site26308WV
3207RH0003XHematology & Oncology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CH6378OTHERWVRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588610570
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMARY ONCOLOGY NETWORK PLLC
Provider Business Mailing Address
First Line : PO BOX 1286
Second Line :
City : FAIRMONT
State : WV
Zip : 26555-1286
Country : US
Telephone Number : 304-366-0111
Fax Number : 304-366-2099
Provider Business Practice Location Address
First Line : 1325 LOCUST AVE STE 15
Second Line :
City : FAIRMONT
State : WV
Zip : 26554-1435
Country : US
Telephone Number : 304-366-0111
Fax Number : 304-366-2099
Authorized Official
Title or Position : OWNER
Name : JOHN JURJUS AZAR
Credential : MD, FACP
Telephone Number : 304-366-0111
Provider Enumeration Date : 05/25/2006
Last Update Date : 11/16/2016

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Directions to “PRIMARY ONCOLOGY NETWORK PLLC ” Practice Location

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