Provider Demographics
NPI:1730161688
Name:ELIZABETHTOWN HEMATOLOGY-ONCOLOGY PLC
Entity type:Organization
Organization Name:ELIZABETHTOWN HEMATOLOGY-ONCOLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NAWEED
Authorized Official - Middle Name:
Authorized Official - Last Name:BEG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-769-6665
Mailing Address - Street 1:1107 WOODLAND DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2789
Mailing Address - Country:US
Mailing Address - Phone:270-769-6665
Mailing Address - Fax:270-769-0322
Practice Address - Street 1:1107 WOODLAND DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2789
Practice Address - Country:US
Practice Address - Phone:270-769-6665
Practice Address - Fax:270-769-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65933970Medicaid
KY1050030OtherPASSPORT
KY1050030OtherPASSPORT