Basic Information
| Provider Information | |||||||||
| NPI: | 1417020082 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRECISION RADIOTHERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136182848 | ||||||||
| FaxNumber: | 5136182849 | ||||||||
| Practice Location | |||||||||
| Address1: | 7710 UNIVERSITY CT | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450692598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134757777 | ||||||||
| FaxNumber: | 5134757778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FODOR | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5136182850 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 1005RT | OH | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 65939217 | 05 | KY | MEDICAID | 7108520 | 01 | OH | AETNA | OTHER | 000000003055 | 01 | OH | ANTHEM | OTHER | 2387859 | 05 | OH | MEDICAID |