=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093090334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATHAN W. UY, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2011
-----------------------------------------------------
Last Update Date | 10/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 W 4TH ST
-----------------------------------------------------
City | COFFEYVILLE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67337-3306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-252-1684
-----------------------------------------------------
Fax | 620-252-1692
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 W 4TH ST PO BOX 993
-----------------------------------------------------
City | COFFEYVILLE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67337-3306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-252-1684
-----------------------------------------------------
Fax | 620-252-1692
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NATHAN W UY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 620-252-1684
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 04-31073
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------