| NPI | 1942208145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA HORTON Provider Enrollment COO Rdinator 800-451-4959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology |
| Additional Taxonomies | 174400000X Specialist (Licence: WV 001) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2022-07-21 |