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General NPI Number Information
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NPI Number | 1730231887
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Entity Type | Organization
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Legal Business Name | OWENSBORO CANCER CENTER PSC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 05/05/2009
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Provider Practice Location Address
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Address Line | 1020 BRECKENRIDGE ST STE 200
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City | OWENSBORO
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State | KY
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Zip | 42303-1784
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Country | US
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Telephone | 270-688-1900
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Fax | 270-688-1905
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Provider Business Mailing Address
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Address Line | PO BOX 1784
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City | OWENSBORO
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State | KY
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Zip | 42302-1784
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Country | US
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Telephone | 270-688-1900
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Fax | 270-688-1905
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Authorized Official
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Title or Position | PRINCIPAL OFFICER
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Name | DATTATRAYA S PRAJAPATI
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Credential | MD
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Telephone | 270-688-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 21298
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License Number State | KY
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