Healthcare Provider Details

I. General information

NPI: 1003905266
Provider Name (Legal Business Name): RADIATION ONCOLOGY OF MISSISSIPPI PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 LAKELAND DR SUITE 34
JACKSON MS
39216-4635
US

IV. Provider business mailing address

970 LAKELAND DR SUITE 34
JACKSON MS
39216-4635
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-0600
  • Fax: 601-362-1186
Mailing address:
  • Phone: 601-362-0600
  • Fax: 601-362-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN E ZACHOW
Title or Position: PRESIDENT
Credential: MD
Phone: 601-376-2074