Healthcare Provider Details

I. General information

NPI: 1841225190
Provider Name (Legal Business Name): SPRINGFIELD HEMATOLOGY AND ONCOLOGY ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W NORTH ST
SPRINGFIELD OH
45504-2547
US

IV. Provider business mailing address

148 W NORTH ST
SPRINGFIELD OH
45504-2547
US

V. Phone/Fax

Practice location:
  • Phone: 937-323-5001
  • Fax: 937-323-5413
Mailing address:
  • Phone: 937-323-5001
  • Fax: 937-323-5413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RAVI C KHANNA
Title or Position: PRESIDENT
Credential: MD
Phone: 93732354001