Provider Demographics
NPI:1205928330
Name:HOPE CANCER CENTER OF NORTHWEST OHIO
Entity type:Organization
Organization Name:HOPE CANCER CENTER OF NORTHWEST OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MADAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-238-0004
Mailing Address - Street 1:825 W MARKET ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2799
Mailing Address - Country:US
Mailing Address - Phone:419-222-6595
Mailing Address - Fax:419-222-6640
Practice Address - Street 1:140 FOX RD
Practice Address - Street 2:SUITE 104
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2475
Practice Address - Country:US
Practice Address - Phone:419-238-0004
Practice Address - Fax:419-238-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2413418Medicaid
OH2413418Medicaid