Healthcare Provider Details

I. General information

NPI: 1538245451
Provider Name (Legal Business Name): WESTERN KENTUCKY RADIATION ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E 18TH ST SUITE 156
OWENSBORO KY
42303-3752
US

IV. Provider business mailing address

PO BOX 16503
CHAPEL HILL NC
27516-6503
US

V. Phone/Fax

Practice location:
  • Phone: 402-432-1072
  • Fax:
Mailing address:
  • Phone: 919-967-6646
  • Fax: 919-967-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberTP861
License Number StateKY

VIII. Authorized Official

Name: DR. GRAE L SCHUSTER
Title or Position: MD
Credential: MD
Phone: 402-432-1072