Healthcare Provider Details

I. General information

NPI: 1356753164
Provider Name (Legal Business Name): NORTHPOINT RADIATION CENTER GP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2077 N WEBB RD
WICHITA KS
67206-3411
US

IV. Provider business mailing address

PO BOX 678083
DALLAS TX
75267-8083
US

V. Phone/Fax

Practice location:
  • Phone: 316-869-2280
  • Fax: 512-583-2001
Mailing address:
  • Phone: 316-869-2280
  • Fax: 512-583-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number1234567
License Number StateKS

VIII. Authorized Official

Name: DAVID DICKEY
Title or Position: CFO
Credential:
Phone: 972-573-4611