Healthcare Provider Details

I. General information

NPI: 1063485639
Provider Name (Legal Business Name): ONCOLOGY & HEMATOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 RAMA DR
INDIANAPOLIS IN
46219-1707
US

IV. Provider business mailing address

250 N. SHADELAND AVE STE 200
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-964-5200
  • Fax: 317-964-5300
Mailing address:
  • Phone: 317-962-4792
  • Fax: 317-962-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW R GREENSPAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 317-594-6900