Basic Information
| Provider Information | |||||||||
| NPI: | 1073610713 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIATION ONCOLOGY CENTERS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3525 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477343525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125830205 | ||||||||
| FaxNumber: | 5125832001 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 MICHIGAN ST NE | ||||||||
| Address2: | STE. 2200 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495032562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164865878 | ||||||||
| FaxNumber: | 6164865785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2006 | ||||||||
| LastUpdateDate: | 11/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | BUTH | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6164865878 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.