Basic Information
| Provider Information | |||||||||
| NPI: | 1053635110 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OKLAHOMA ONCOLOGY AND HEMATOLOGY, P.C. | ||||||||
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| OtherOrganizationName: | CANCER CARE ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 W MEMORIAL RD | ||||||||
| Address2: | 138 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731341785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059362812 | ||||||||
| FaxNumber: | 4059362891 | ||||||||
| Practice Location | |||||||||
| Address1: | 4301 S WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056310919 | ||||||||
| FaxNumber: | 4056360518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2010 | ||||||||
| LastUpdateDate: | 03/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | CANFIELD | ||||||||
| AuthorizedOfficialFirstName: | VIKKI | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PAST PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4057514343 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OKLAHOMA ONCOLOGY AND HEMATOLOGY, P.C. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 100744480A | 05 | OK | MEDICAID |