Healthcare Provider Details

I. General information

NPI: 1669659355
Provider Name (Legal Business Name): ADAMS COUNTY CANCER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 MEDICAL CENTER DRIVE
SEAMAN OH
45679-8006
US

IV. Provider business mailing address

285 MEDICAL CENTER DRIVE
SEAMAN OH
45679-8006
US

V. Phone/Fax

Practice location:
  • Phone: 937-386-0000
  • Fax: 937-386-0009
Mailing address:
  • Phone: 937-386-0000
  • Fax: 937-386-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35091254
License Number StateOH

VIII. Authorized Official

Name: DR. PRAKASH B. PATEL
Title or Position: MEMBER MANAGER
Credential: M.D.
Phone: 937-386-0000