Provider Demographics
NPI:1588903587
Name:MEADOWS REGIONAL CANCER CENTER
Entity type:Organization
Organization Name:MEADOWS REGIONAL CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO - SRPCC
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:OSTEEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:912-537-9861
Mailing Address - Street 1:1 MEADOWS PKWY
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8759
Mailing Address - Country:US
Mailing Address - Phone:912-535-5800
Mailing Address - Fax:
Practice Address - Street 1:1 MEADOWS PKWY
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8759
Practice Address - Country:US
Practice Address - Phone:912-535-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty