NPIMap

Organization Active NPI

Southern Oncology Specialists, PLLC

  • Hematology & Oncology Physician
  • Huntersville, NC
National Provider Identifier
1336455674
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
34407 Issued in NC
Legal business name
SOUTHERN ONCOLOGY SPECIALISTS, PLLC
Practice address
9930 Kincey Ave Ste 165
Huntersville, NC 28078-6541
Phone
(704) 947-5005
Fax
(877) 881-8455
NPI assigned
Aug 24, 2010
Last updated
Aug 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. William R Mitchell, MDNPI 1811949308
Title
Owner/MD
Phone
(704) 945-6843

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 34407 NC
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X 34407 NC Primary
Specialty Pharmacy 3336S0011X 13089 NC

Addresses

Primary practice location

9930 Kincey Ave Ste 165
Huntersville, NC 28078-6541

Mailing address

9930 Kincey Ave Ste 165
Huntersville, NC 28078-6541
Phone (047) 947-5005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100921001014 NC Part B Supplier - Clinic/Group Practice 4082739560 Receives reassigned benefits from 15 practitioners
Practice locations: Charlotte, NC; Denver, NC; Huntersville, NC; Mooresville, NC; Statesville, NC
O20110318000462 NC DME Supplier - Physician - Medical Oncology 4082739560 Practice locations: Huntersville, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

268 Gillman Rd
Denver, NC 28037

10030 Gilead Rd
Ste 290
Huntersville, NC 28078
Phone (704) 947-5005

146 Medical Park Rd
Ste 212
Mooresville, NC 28117
Phone (704) 659-7844

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1336455674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9930 KINCEY AVE STE 165",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280786541",
            "telephone_number": "047-947-5005",
            "fax_number": "877-881-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9930 KINCEY AVE STE 165",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280786541",
            "telephone_number": "704-947-5005",
            "fax_number": "877-881-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ONCOLOGY SPECIALISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-24",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "704-945-6843",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "34407",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NC",
            "license": "34407",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "NC",
            "license": "13089",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.