Basic Information
| Provider Information | |||||||||
| NPI: | 1104071893 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GAINESVILLE CANCER CENTER | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 270690 | ||||||||
| Address2: | |||||||||
| City: | FLOWER MOUND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750270690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403878000 | ||||||||
| FaxNumber: | 9403834797 | ||||||||
| Practice Location | |||||||||
| Address1: | 1615 HOSPITAL BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403878000 | ||||||||
| FaxNumber: | 9403834797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2008 | ||||||||
| LastUpdateDate: | 11/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCHWARTZ | ||||||||
| AuthorizedOfficialFirstName: | SHERRI | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9403878000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | K2566 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.