Healthcare Provider Details

I. General information

NPI: 1487621496
Provider Name (Legal Business Name): ONCOLOGY AND HEMATOLOGY ASSOCIATES OF SOUTHWEST VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 JEFFERSON ST SW SECOND FLOOR
ROANOKE VA
24014-2419
US

IV. Provider business mailing address

2013 JEFFERSON ST SW SECOND FLOOR
ROANOKE VA
24014-2419
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-0237
  • Fax: 540-982-2719
Mailing address:
  • Phone: 540-982-0237
  • Fax: 540-982-2719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TIFFANY HOUSMAN-BUSSEY
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 540-982-0237