Provider Demographics
NPI:1154367555
Name:NORTHCOAST RADIOTHERAPY INC.
Entity type:Organization
Organization Name:NORTHCOAST RADIOTHERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHEROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-625-6647
Mailing Address - Street 1:703 TYLER ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3367
Mailing Address - Country:US
Mailing Address - Phone:419-625-6647
Mailing Address - Fax:
Practice Address - Street 1:1101 DECATUR ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3335
Practice Address - Country:US
Practice Address - Phone:419-625-6647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty