Basic Information
| Provider Information | |||||||||
| NPI: | 1669564258 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIATION ONCOLOGY SERVICES APMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30015 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182124639 | ||||||||
| FaxNumber: | 3182128305 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 KINGS HWY. | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182124639 | ||||||||
| FaxNumber: | 3182128305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 12/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | KATZ | ||||||||
| AuthorizedOfficialFirstName: | SANFORD | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3182124639 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1446556 | 05 | LA | MEDICAID |