Provider Demographics
NPI:1194952150
Name:CONKLIN REGIONAL CANCER CENTER PC
Entity type:Organization
Organization Name:CONKLIN REGIONAL CANCER CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-622-5613
Mailing Address - Street 1:620 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4554
Mailing Address - Country:US
Mailing Address - Phone:605-622-5613
Mailing Address - Fax:605-622-5056
Practice Address - Street 1:620 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4554
Practice Address - Country:US
Practice Address - Phone:605-622-5613
Practice Address - Fax:605-622-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty