Basic Information
| Provider Information | |||||||||
| NPI: | 1457546475 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLEVELAND RADIATION ONCOLOGY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2865 E COAST HWY | ||||||||
| Address2: | 210 | ||||||||
| City: | CORONA DEL MAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926252236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492073111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5260 SMITH RD | ||||||||
| Address2: | |||||||||
| City: | BROOKPARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441421747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162654580 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2007 | ||||||||
| LastUpdateDate: | 10/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | PRESCOTT | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4408166015 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.