Basic Information
| Provider Information | |||||||||
| NPI: | 1316342090 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONCOLOGY HEMATOLOGY CARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5053 WOOSTER RD | ||||||||
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| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452262326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137512145 | ||||||||
| FaxNumber: | 5137512138 | ||||||||
| Practice Location | |||||||||
| Address1: | 148 W NORTH ST | ||||||||
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| City: | SPRINGFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 455042547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007104674 | ||||||||
| FaxNumber: | 9373235495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2014 | ||||||||
| LastUpdateDate: | 10/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | SCHRADER | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5137512145 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 207RH0003X | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0392838 | 05 | OH | MEDICAID |