MEDICARE: NORTHERN OHIO REGIONAL CANCER CENTER

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	261QX0203X	Radiation Oncology Clinic/Center	35062430	OH

General Provider Information

NPI Number	:	1962735852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN OHIO REGIONAL CANCER CENTER

Provider Business Mailing Address
First Line	:	5260 SMITH RD
Second Line	:
City	:	BROOK PARK
State	:	OH
Zip	:	44142-1747
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5260 SMITH RD
Second Line	:
City	:	BROOK PARK
State	:	OH
Zip	:	44142-1747
Country	:	US
Telephone Number	:	216-265-4580
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JON PRESCOTT
Credential	:	MD
Telephone Number	:	216-265-4580

Provider Enumeration Date	:	09/10/2009
Last Update Date	:	09/10/2009

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