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General NPI Number Information
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NPI Number | 1225274244
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Entity Type | Organization
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Legal Business Name | TRI-STATE RADIATION ONCOLOGY CENTERS LLC
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Dates
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Enumeration Date | 12/22/2008
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Last Update Date | 10/01/2009
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Provider Practice Location Address
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Address Line | 700 N BURKHARDT RD
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City | EVANSVILLE
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State | IN
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Zip | 47715-2740
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Country | US
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Telephone | 812-474-1110
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Fax | 812-474-1303
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Provider Business Mailing Address
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Address Line | PO BOX 2084
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-2084
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Country | US
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Telephone | 800-331-9294
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Fax | 812-471-9282
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Authorized Official
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Title or Position | CHAIRPERSON
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Name | JOE CHANG
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Credential |
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Telephone | 310-335-4000
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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