Healthcare Provider Details

I. General information

NPI: 1053364885
Provider Name (Legal Business Name): OZA ONCOLOGY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 VETERANS MEMORIAL DR
MOUNT VERNON IL
62864-6262
US

IV. Provider business mailing address

PO BOX 948 4117 VETERANS MEMORIAL DR.
MOUNT VERNON IL
62864-0020
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-6500
  • Fax: 618-244-6422
Mailing address:
  • Phone: 618-244-6500
  • Fax: 618-244-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YAGNESH V OZA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 618-244-6500