MEDICARE: ONCOLOGY CARE ASSOCIATES, PLLC

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	207RH0003X	Hematology & Oncology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ9788	OTHER	MI	RAILROAD MEDICARE GROUP #

Other Identifiers

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

General Provider Information

NPI Number	:	1982637104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONCOLOGY CARE ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	3380 LINCOLN AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-3703
Country	:	US
Telephone Number	:	269-985-0029
Fax Number	:	269-985-0040

Provider Business Practice Location Address
First Line	:	820 LESTER AVE
Second Line	:	119
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-2561
Country	:	US
Telephone Number	:	269-985-0029
Fax Number	:	269-985-0040

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC POWELL LESTER
Credential	:	MD
Telephone Number	:	269-985-0029

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	11/08/2007

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Directions to “ONCOLOGY CARE ASSOCIATES, PLLC ” Practice Location

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