Southern Cook Radiation Oncology LTD

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

Legal business name

SOUTHERN COOK RADIATION ONCOLOGY LTD

Practice address

2310 York St
Suite M
Blue Island, IL 60406-2411

Phone

(708) 396-0910

Fax

(708) 388-4354

NPI assigned

Nov 8, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Gregorio M Tolentino Jr., MD

Title

Officer

Phone

(708) 396-0910

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279843200000",
    "number": "1487635314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 379",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604620379",
            "telephone_number": "708-460-9836",
            "fax_number": "708-460-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 YORK ST",
            "address_2": "SUITE M",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062411",
            "telephone_number": "708-396-0910",
            "fax_number": "708-388-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COOK RADIATION ONCOLOGY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-08",
        "last_updated": "2010-07-23",
        "status": "A",
        "authorized_official_last_name": "TOLENTINO",
        "authorized_official_first_name": "GREGORIO",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "708-396-0910",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GR",
            "identifier": "CL9637",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IL GR #",
            "identifier": "1617459",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raneem R Sheblak, DDS
• Mouhammed K Sheikha, MD
• Ukela Shelton
• David Oludamilola Sode, PA
• Pamela Lynn Solomon
• SSM Health Businesses (SSM Hospice at St. Francis Blue Island)
• SSM Home Care at St. Francis Blue Island
• SSM Regional Health Services Owning and Operating St Francis Hospital (St. Francis Hospital & Health Center)
• Raymond Jerome Stadt, ATC
• Ashley Stalter

• Radiation Oncology Physician in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Radiation Oncology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.