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General NPI Number Information
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NPI Number | 1952649360
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Entity Type | Organization
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Legal Business Name | THOMAS JOHNS CANCER HOSPITAL AT JOHNSTON WILLIS HOSPITAL
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 1401 JOHNSTON WILLIS DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-4730
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Country | US
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Telephone | 804-330-2323
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Fax | 804-267-6130
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Provider Business Mailing Address
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Address Line | 1401 JOHNSTON WILLIS DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-4730
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Country | US
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Telephone | 804-330-2323
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Fax | 804-267-6130
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Authorized Official
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Title or Position | ONCOLOGY ADMINISTRATOR
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Name | SUSANNE COLLIGON
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Credential | NP
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Telephone | 804-267-6074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 0001159082
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License Number State | VA
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