Organization
SOUTHSIDE RADIATION ONCOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER WILLIAMS (BILLING SPECIALIST)
(336) 378-0076
Entity
Organization
Contact information
Practice address
320 HOSPITAL DR, MEMORIAL HOSPITAL, MARTINSVILLE, VA 24112-1900
(276) 666-7200
Mailing address
PO BOX 13624, GREENSBORO, NC 27415-3624
(336) 274-4285
(336) 274-8097
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
0101032577
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
186856
ANTHEM BCBS
—
05
—
8936188
—
NC
Enumeration date
05/15/2007
Last updated
10/15/2007
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