Organization
SPRINGFIELD REGIONAL CANCER CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RENE SUNTAY (VP, CHIEF FINANCIAL OFFICER)
(937) 323-5001
Entity
Organization
Contact information
Practice address
148 W NORTH ST, SPRINGFIELD, OH 45504-2547
(937) 323-5001
(937) 323-5413
Mailing address
148 W NORTH ST, SPRINGFIELD, OH 45504-2547
(937) 323-5001
(937) 323-5413
Taxonomy
Speciality
Code
Description
License number
State
2471R0002X
Radiation Therapy Radiologic Technologist
1097RT
OH
261QX0203X
Radiation Oncology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000339942
ANTHEM BC/BS PROVIDER #
OH
01
—
2468517
UHC PROVIDER #
OH
05
—
2516361
—
OH
01
—
7378615
AETNA PROVIDER #
OH
Enumeration date
08/30/2005
Last updated
09/11/2018
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