Provider Demographics
NPI:1538245451
Name:WESTERN KENTUCKY RADIATION ONCOLOGY
Entity type:Organization
Organization Name:WESTERN KENTUCKY RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-432-1072
Mailing Address - Street 1:PO BOX 16503
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-6503
Mailing Address - Country:US
Mailing Address - Phone:919-967-6646
Mailing Address - Fax:919-967-6647
Practice Address - Street 1:117 E 18TH ST
Practice Address - Street 2:SUITE 156
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3752
Practice Address - Country:US
Practice Address - Phone:402-432-1072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP8612085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYA03532Medicare UPIN