Basic Information
| Provider Information | |||||||||
| NPI: | 1306897996 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST RADIATION ONCOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3807 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681030807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025722265 | ||||||||
| FaxNumber: | 4025722031 | ||||||||
| Practice Location | |||||||||
| Address1: | 3764 39TH AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 686014564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025628666 | ||||||||
| FaxNumber: | 4025628426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 05/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | KEIT | ||||||||
| AuthorizedOfficialFirstName: | JOAN | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4025722265 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 |
ID Information
| ID | Type | State | Issuer | Description | DE9388 | 01 | NE | RAILROAD MEDICARE | OTHER |