Provider Demographics
NPI:1306897996
Name:MIDWEST RADIATION ONCOLOGY PC
Entity type:Organization
Organization Name:MIDWEST RADIATION ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:KEIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-572-2265
Mailing Address - Street 1:PO BOX 3807
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0807
Mailing Address - Country:US
Mailing Address - Phone:402-572-2265
Mailing Address - Fax:402-572-2031
Practice Address - Street 1:3764 39TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4564
Practice Address - Country:US
Practice Address - Phone:402-562-8666
Practice Address - Fax:402-562-8426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEDE9388OtherRAILROAD MEDICARE
NEDE9388OtherRAILROAD MEDICARE