Basic Information
| Provider Information | |||||||||
| NPI: | 1306936299 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHENANDOAH ONCOLOGY ASSOCIATES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SHENANDOAH ONCOLOGY LAB | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1870 AMHERST ST | ||||||||
| Address2: | SUITE F | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406621108 | ||||||||
| FaxNumber: | 5406673408 | ||||||||
| Practice Location | |||||||||
| Address1: | 1870 AMHERST ST | ||||||||
| Address2: | SUITE F | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406621108 | ||||||||
| FaxNumber: | 5406673408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 07/11/2007 | ||||||||
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| AuthorizedOfficialLastName: | GUAY | ||||||||
| AuthorizedOfficialFirstName: | JOANN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5406621108 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 009696 | 01 | VA | COLA ID | OTHER |