Organization
CLARK RADIATION ONCOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA VICTOR (PRESIDENT)
(937) 323-5425
Entity
Organization
Contact information
Practice address
148 W NORTH ST, SPRINGFIELD, OH 45504-2547
(937) 323-5425
(937) 323-5495
Mailing address
148 W NORTH ST, SPRINGFIELD, OH 45504-2547
(937) 323-5425
(937) 323-5495
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9920792
MEDICARE GROUP ID
OH
Enumeration date
07/14/2006
Last updated
01/24/2014
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