Provider Demographics
NPI:1316914161
Name:ANDERSON ONCOLOGY-HEMATOLOGY CLINIC PA
Entity type:Organization
Organization Name:ANDERSON ONCOLOGY-HEMATOLOGY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-224-5765
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:STE 5000
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1580
Mailing Address - Country:US
Mailing Address - Phone:864-224-5765
Mailing Address - Fax:864-224-1449
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:STE 5000
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-224-5765
Practice Address - Fax:864-224-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC4385Medicaid
SCCB3367OtherRR MEDICARE
SCCB3367OtherRR MEDICARE
SC2405Medicare PIN