Organization
RADIATION ONCOLOGY PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRISTAN STA.ELENA BRIONES MD (OWNER)
(270) 926-7228
Entity
Organization
Contact information
Practice address
1000 BRECKENRIDGE STREET, SUITE 203, OWENSBORO, KY 42303-0876
(270) 926-7228
(270) 926-6559
Mailing address
1000 BRECKENRIDGE STREET, SUITE 203, OWENSBORO, KY 42303-0876
(270) 926-7228
(270) 926-6559
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
17318
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000040652
ANTHEM
KY
01
—
260109
BLACK LUNG
KY
01
—
50003514
PASSPORT HEALTH PLAN
KY
05
—
65907636
—
KY
01
—
RO 1278131
UMWA HEALTH & RETIREMENT
KY
Enumeration date
09/27/2006
Last updated
08/22/2020
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