Healthcare Provider Details

I. General information

NPI: 1467731224
Provider Name (Legal Business Name): RICHMOND CANCER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 REID PARKWAY SUITE 120
RICHMOND IN
47374-1156
US

IV. Provider business mailing address

3333 BISHOPS GATE
RICHMOND IN
47374-7933
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-3245
  • Fax: 765-983-3247
Mailing address:
  • Phone: 765-983-3245
  • Fax: 765-983-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: XIUSHENG QIN
Title or Position: SOLE MEMBER
Credential: MD
Phone: 765-983-3245