Basic Information
| Provider Information | |||||||||
| NPI: | 1205883378 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONCOLOGY HEMATOLOGY CONSULTANTS, PSC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PURCHASE CANCER GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 KIANA CT | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420016787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705540011 | ||||||||
| FaxNumber: | 2705546540 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 KIANA CT | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420016787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705540011 | ||||||||
| FaxNumber: | 2705546540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 08/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | WINKLER | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2705540011 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 372380 | 05 | TN | MEDICAID | 65941197 | 05 | KY | MEDICAID |