Healthcare Provider Details

I. General information

NPI: 1922057850
Provider Name (Legal Business Name): HENDERSON CANCER CENTER PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N ELM ST
HENDERSON KY
42420-2784
US

IV. Provider business mailing address

PO BOX 15040
EVANSVILLE IN
47716-0040
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-0255
  • Fax: 270-826-5342
Mailing address:
  • Phone: 812-476-1367
  • Fax: 812-477-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALVIN NONE KORBA
Title or Position: PRESIDENT
Credential: MEDICAL DOCTOR
Phone: 270-826-0255