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General NPI Number Information
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NPI Number | 1194220897
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Entity Type | Organization
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Legal Business Name | SOUTH CAMPUS PARTNERS, INC.
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 15300 WEST AVE BLDG A
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City | ORLAND PARK
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State | IL
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Zip | 60462-4600
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Country | US
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Telephone | 708-873-2450
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Fax | 708-873-2455
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Provider Business Mailing Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-3708
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Fax |
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Authorized Official
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Title or Position | CHAIRPERSON & PRESIDENT
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Name | TERRENCE MOISAN
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Credential | M.D.
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Telephone | 708-873-2450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number |
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License Number State |
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