Basic Information
| Provider Information | |||||||||
| NPI: | 1295991727 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONCOLOGY HEMATOLOGY CARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7380 TURFWAY RD | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410421355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593416660 | ||||||||
| FaxNumber: | 8595783045 | ||||||||
| Practice Location | |||||||||
| Address1: | 7380 TURFWAY RD | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410421355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593416660 | ||||||||
| FaxNumber: | 8595783045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 09/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | LEVY | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5137512145 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 | 65933715 | 05 | KY | MEDICAID |