Basic Information
| Provider Information | |||||||||
| NPI: | 1689629156 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONCOLOGY/ HEMATOLOGY CARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 KIPLING AVE | ||||||||
| Address2: | STE 111 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452396600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137512273 | ||||||||
| FaxNumber: | 5135413386 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 KIPLING AVE STE 111 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452396699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137512273 | ||||||||
| FaxNumber: | 5135413386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 12/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | GORDON | ||||||||
| AuthorizedOfficialFirstName: | ABRAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO / GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 5137512145 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 2656479 | 05 | OH | MEDICAID |