The Medical Oncology Group

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

THE MEDICAL ONCOLOGY GROUP

Practice address

1340 Broad Ave
Suite 270
Gulfport, MS 39501-2404

Phone

(228) 575-1234

Fax

(228) 575-1240

NPI assigned

Dec 19, 2005

Last updated

Sep 16, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Edwin M Davidson, MDNPI 1831175280

Title

Senior Partner/Physician

Phone

(228) 575-1234

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

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.

• Edwin M Davidson, MD

  • Medical Oncology Physician
  • Gulfport, MS
  • NPI 1831175280
  Authorized official Same address or phone
• Leona R. Lenaz, CFNP

  • Nurse Practitioner
  • Marietta, GA
  • NPI 1396883716
  NPD (past)
• Matthew J Sacks, MD

  • Specialist
  • Walla Walla, WA
  • NPI 1528014420
  NPD (past)

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284595200000",
    "number": "1639155088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1210",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395021210",
            "telephone_number": "228-575-1234",
            "fax_number": "228-575-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 BROAD AVE",
            "address_2": "SUITE 270",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012404",
            "telephone_number": "228-575-1234",
            "fax_number": "228-575-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MEDICAL ONCOLOGY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-19",
        "last_updated": "2010-09-16",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SENIOR PARTNER/PHYSICIAN",
        "authorized_official_telephone_number": "228-575-1234",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09012355",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Heather Lynn Theisen, ARNP
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• Specialist in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Specialist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.