MEDICARE: NORFOLK RADIAITON ONCOLOGY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse

General Provider Information

NPI Number	:	1174721716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORFOLK RADIAITON ONCOLOGY, PC

Provider Business Mailing Address
First Line	:	PO BOX 1666
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68702-1666
Country	:	US
Telephone Number	:	402-371-0925
Fax Number	:	402-371-0925

Provider Business Practice Location Address
First Line	:	2425 TAYLOR AVE
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-4511
Country	:	US
Telephone Number	:	402-371-5070
Fax Number	:	402-371-5070

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MOHAMMED K ZAHRA
Credential	:	MD
Telephone Number	:	402-371-0925

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	07/13/2007

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