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NPI Code Detail

MEDICARE: ONCOLOGY-HEMATOLOGY CONSULTANTS PA

MEDICARE: ONCOLOGY-HEMATOLOGY CONSULTANTS PA
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
1207RH0000XHematology (Internal Medicine) Physician
2207RH0002XHospice and Palliative Medicine (Internal Medicine) Physician
3207VG0400XGynecology Physician
42085R0001XRadiation Oncology Physician
5208600000XSurgery Physician
6207RH0003XHematology & Oncology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669425617
Entity Type Code : Organization
Provider Name (Legal Business Name) : ONCOLOGY-HEMATOLOGY CONSULTANTS PA
Provider Business Mailing Address
First Line : PO BOX 164009
Second Line :
City : FORT WORTH
State : TX
Zip : 76161-4009
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 920 SANTA FE DR
Second Line :
City : WEATHERFORD
State : TX
Zip : 76086-5864
Country : US
Telephone Number : 817-596-0637
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : BARRY RUSSO
Credential :
Telephone Number : 817-333-0175
Provider Enumeration Date : 05/19/2006
Last Update Date : 10/28/2020

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Directions to “ONCOLOGY-HEMATOLOGY CONSULTANTS PA ” Practice Location

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