Basic Information
| Provider Information | |||||||||
| NPI: | 1356753164 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHPOINT RADIATION CENTER GP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 678083 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752678083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168692280 | ||||||||
| FaxNumber: | 5125832001 | ||||||||
| Practice Location | |||||||||
| Address1: | 2077 N WEBB RD | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672063411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168692280 | ||||||||
| FaxNumber: | 5125832001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2014 | ||||||||
| LastUpdateDate: | 05/28/2014 | ||||||||
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| AuthorizedOfficialLastName: | DICKEY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9725734611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0203X | 1234567 | KS | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology, Radiation |
No ID Information.