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General NPI Number Information
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NPI Number | 1740590397
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Entity Type | Organization
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Legal Business Name | SKPR OH 1 LLC
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 915 10TH ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-4152
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Country | US
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Telephone | 937-386-0000
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Fax | 937-386-0009
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Provider Business Mailing Address
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Address Line | 285 MEDICAL CENTER DR
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City | SEAMAN
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State | OH
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Zip | 45679-8006
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Country | US
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Telephone | 937-386-0000
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Fax | 937-386-0009
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Authorized Official
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Title or Position | SOLE MEMBER/MANAGER
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Name | PRAKASH B PATEL
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Credential | M.D.
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Telephone | 937-386-0000
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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 | 35053209
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License Number State | OH
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