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General NPI Number Information
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NPI Number | 1174858039
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Entity Type | Organization
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Legal Business Name | PREMIER RADIATION ONCOLOGY, INC.
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Dates
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Enumeration Date | 10/12/2009
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 2900 1ST AVE
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City | HUNTINGTON
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State | WV
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Zip | 25702-1241
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Country | US
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Telephone | 304-526-1143
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Fax | 304-526-8942
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Provider Business Mailing Address
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Address Line | PO BOX 1104
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City | RAHWAY
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State | NJ
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Zip | 07065-1104
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Country | US
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Telephone | 973-444-2664
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Fax | 732-943-2702
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Authorized Official
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Title or Position | BILLING DIRECTOR
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Name | DIANE MILLER
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Credential |
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Telephone | 973-444-2664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 11879
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License Number State | WV
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