Organization
JAMESTOWN MEDICAL ONCOLOGY HEMATOLOGY, LLC
Active
Other names
Jamestown Medical Oncology Hematology, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN GABUTEN IBABAO (PRACTICE MANAGER)
(716) 664-1909
Entity
Organization
Contact information
Practice address
21 PORTER AVE, JAMESTOWN, NY 14701-6247
(716) 664-1909
(716) 664-2214
Mailing address
PO BOX 9, JAMESTOWN, NY 14702-0009
(716) 664-1909
(716) 664-2214
Taxonomy
Speciality
Code
Description
License number
State
261QX0200X
Oncology Clinic/Center
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010352702
UNIVERA HEALTHCARE
NY
01
—
000524493003
BCBS OF WNY
NY
01
—
0007232005
AETNA
NY
01
—
000866280
MGP
NY
01
—
0191329
INDEPENDENT HEALTH
NY
05
—
02365855
—
NY
01
—
040403007130
FIDELIS
NY
01
—
11303
MAGNACARE
NY
01
—
1294660001
NHIC DME JURISDICTION A
NY
01
—
714714
MVP
NY
01
—
7200341
GHI
NY
01
—
AA0630
MEDICARE
NY
01
—
CG8430
RR MEDICARE
NY
Enumeration date
10/25/2006
Last updated
07/21/2022
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