Healthcare Provider Details

I. General information

NPI: 1629044839
Provider Name (Legal Business Name): MEDICAL ONCOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 MEDICAL DR
CLARKSDALE MS
38614
US

IV. Provider business mailing address

PO BOX 1887
CLARKSDALE MS
38614
US

V. Phone/Fax

Practice location:
  • Phone: 662-627-7163
  • Fax: 662-627-7150
Mailing address:
  • Phone: 662-627-7163
  • Fax: 662-627-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MTANIUS A SULTANI
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 662-627-7163