Provider Demographics
NPI:1053348904
Name:CANCER NETWORK OF WEST CENTRAL OHIO
Entity type:Organization
Organization Name:CANCER NETWORK OF WEST CENTRAL OHIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-251-2662
Mailing Address - Street 1:900 HAVEMANN ROAD
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-1870
Mailing Address - Country:US
Mailing Address - Phone:419-584-1900
Mailing Address - Fax:
Practice Address - Street 1:900 HAVEMANN ROAD
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1870
Practice Address - Country:US
Practice Address - Phone:419-584-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CANCER NETWORK OF WEST CENTRAL OHIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-27
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1055RT261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2429821Medicaid
TH9341181Medicare Oscar/Certification
OH9341181Medicare ID - Type Unspecified