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General NPI Number Information
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NPI Number | 1649510959
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Entity Type | Organization
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Legal Business Name | CANCER SERVICES OF GRANT COUNTY INC.
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Dates
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Enumeration Date | 02/22/2013
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 305 S. NORTON AVE.
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City | MARION
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State | IN
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Zip | 46952
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Country | US
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Telephone | 765-664-6815
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Fax | 765-664-1636
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Provider Business Mailing Address
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Address Line | 305 S. NORTON AVE.
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City | MARION
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State | IN
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Zip | 46952
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Country | US
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Telephone | 765-664-6815
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Fax | 765-664-1636
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JENNIFER SUE LANE-RIEFLER
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Credential | MCHES
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Telephone | 765-664-6815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | IN
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