Provider Demographics
NPI:1316993405
Name:ONCOLOGY GROUP INC.
Entity type:Organization
Organization Name:ONCOLOGY GROUP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-536-0223
Mailing Address - Street 1:900 GREENLEY RD
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5287
Mailing Address - Country:US
Mailing Address - Phone:209-536-0223
Mailing Address - Fax:
Practice Address - Street 1:900 GREENLEY RD
Practice Address - Street 2:SUITE 901
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5287
Practice Address - Country:US
Practice Address - Phone:209-536-0223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG615792085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0007340Medicaid
CA00G615791Medicaid
DF5758OtherRAIL ROAD MEDICARE
CA00G615792Medicare ID - Type Unspecified
ZZZ04913ZMedicare PIN