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NPI Code Detail

MEDICARE: CLARK RADIATION ONCOLOGY

MEDICARE: CLARK RADIATION ONCOLOGY
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
1174400000XSpecialist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19920792OTHEROHMEDICARE GROUP ID

General Provider Information

NPI Number : 1801812953
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLARK RADIATION ONCOLOGY
Provider Business Mailing Address
First Line : 148 W NORTH ST
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45504-2547
Country : US
Telephone Number : 937-323-5425
Fax Number : 937-323-5495
Provider Business Practice Location Address
First Line : 148 W NORTH ST
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45504-2547
Country : US
Telephone Number : 937-323-5425
Fax Number : 937-323-5495
Authorized Official
Title or Position : PRESIDENT
Name : SANDRA VICTOR
Credential :
Telephone Number : 937-323-5425
Provider Enumeration Date : 07/14/2006
Last Update Date : 01/24/2014

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Directions to “CLARK RADIATION ONCOLOGY ” Practice Location

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