Healthcare Provider Details

I. General information

NPI: 1750385183
Provider Name (Legal Business Name): ONCOLOGY HEMATOLOGY MEDICAL ASSOCIATES OF THE CENTRAL COAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 TANK FARM ROAD
SAN LUIS OBISPO CA
93401-4140
US

IV. Provider business mailing address

715 TANK FARM ROAD
SAN LUIS OBISPO CA
93401-4140
US

V. Phone/Fax

Practice location:
  • Phone: 805-543-5577
  • Fax: 805-595-3231
Mailing address:
  • Phone: 805-543-5577
  • Fax: 805-595-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2368027
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS L. SPILLANE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-543-5577