Healthcare Provider Details

I. General information

NPI: 1730161688
Provider Name (Legal Business Name): ELIZABETHTOWN HEMATOLOGY-ONCOLOGY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 WOODLAND DR SUITE 105
ELIZABETHTOWN KY
42701-2789
US

IV. Provider business mailing address

1107 WOODLAND DR SUITE 105
ELIZABETHTOWN KY
42701-2789
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-6665
  • Fax: 270-769-0322
Mailing address:
  • Phone: 270-769-6665
  • Fax: 270-769-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. NAWEED BEG
Title or Position: OFFICE MANGER
Credential:
Phone: 270-769-6665