=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184948242
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OKLAHOMA ONCOLOGY AND HEMATOLOGY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2010
-----------------------------------------------------
Last Update Date | 03/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 N STRONG BLVD
-----------------------------------------------------
City | MCALESTER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74501-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-426-0625
-----------------------------------------------------
Fax | 918-423-0695
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4401 W MEMORIAL RD 138
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73134-1785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-936-2812
-----------------------------------------------------
Fax | 405-936-2891
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PAST PRESIDENT
-----------------------------------------------------
Name | VIKKI ANN CANFIELD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 405-751-4343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------