Healthcare Provider Details

I. General information

NPI: 1891866562
Provider Name (Legal Business Name): HEMATOLOGY & ONCOLOGY CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MERCY DR SUITE 10
COUNCIL BLUFFS IA
51503-3128
US

IV. Provider business mailing address

PO BOX 641850
OMAHA NE
68164-7850
US

V. Phone/Fax

Practice location:
  • Phone: 712-388-2810
  • Fax: 712-388-2812
Mailing address:
  • Phone: 402-572-3529
  • Fax: 402-572-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number23365
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number32519
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number33127
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number23373
License Number StateIA
# 5
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number32052
License Number StateIA

VIII. Authorized Official

Name: MRS. CAROLYNNE RENEA PARKER
Title or Position: CLINIC COORDINATOR
Credential:
Phone: 402-572-3529