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Organization

TRI-STATE RADIATION ONCOLOGY CENTERS LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOE CHANG (CHAIRPERSON)
(310) 335-4000
Entity
Organization

Contact information

Practice address
700 N BURKHARDT RD, EVANSVILLE, IN 47715-2740
(812) 474-1110
(812) 474-1303
Mailing address
PO BOX 2084, INDIANAPOLIS, IN 46206-2084
(800) 331-9294
(812) 471-9282

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
2085R0202X
Diagnostic Radiology Physician
261QX0203X
Radiation Oncology Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200926120A
IN
05
200926120B
IN
01
DP0313
RR MEDICARE
IN
Enumeration date
12/22/2008
Last updated
10/01/2009
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