Healthcare Provider Details

I. General information

NPI: 1093035628
Provider Name (Legal Business Name): ONSLOW RADIATION ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2010
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 WESTERN BLVD
JACKSONVILLE NC
28546-6338
US

IV. Provider business mailing address

PO BOX 96849
CHARLOTTE NC
28296-6849
US

V. Phone/Fax

Practice location:
  • Phone: 910-577-4900
  • Fax: 910-577-4910
Mailing address:
  • Phone: 910-577-4900
  • Fax: 910-577-4910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number067-1440-A1
License Number StateNC

VIII. Authorized Official

Name: CARL E BIBER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 910-577-2969