Healthcare Provider Details

I. General information

NPI: 1255412862
Provider Name (Legal Business Name): CANCER OUTREACH ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ABINGDON PL
ABINGDON VA
24211-5197
US

IV. Provider business mailing address

104 ABINGDON PL
ABINGDON VA
24211-5197
US

V. Phone/Fax

Practice location:
  • Phone: 276-676-1860
  • Fax: 276-628-2917
Mailing address:
  • Phone: 276-676-1860
  • Fax: 276-628-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number0213000796
License Number StateVA

VIII. Authorized Official

Name: JEFFREY ALLEN HUNDMAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 276-676-1865