Basic Information
| Provider Information | |||||||||
| NPI: | 1629044839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL ONCOLOGY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1887 | ||||||||
| Address2: | |||||||||
| City: | CLARKSDALE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6626277163 | ||||||||
| FaxNumber: | 6626277150 | ||||||||
| Practice Location | |||||||||
| Address1: | 581 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | CLARKSDALE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6626277163 | ||||||||
| FaxNumber: | 6626277150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 07/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | SULTANI | ||||||||
| AuthorizedOfficialFirstName: | MTANIUS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6626277163 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MEDICAL ONCOLOGY INC | ||||||||
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| NPICertificationDate: | 07/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.