Provider Demographics
NPI:1386754943
Name:MEDICAL ONCOLOGY AND HEMATOLOGY PC
Entity type:Organization
Organization Name:MEDICAL ONCOLOGY AND HEMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAMBHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-552-9800
Mailing Address - Street 1:4242 FARNAM ST
Mailing Address - Street 2:STE 590
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2806
Mailing Address - Country:US
Mailing Address - Phone:402-552-9800
Mailing Address - Fax:402-552-9898
Practice Address - Street 1:4242 FARNAM ST
Practice Address - Street 2:STE 590
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2806
Practice Address - Country:US
Practice Address - Phone:402-552-9800
Practice Address - Fax:402-552-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20832207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4260497Medicaid
NE10025280000Medicaid
MO502181506Medicaid
NE10025280000Medicaid
NE099754Medicare PIN