Basic Information
| Provider Information | |||||||||
| NPI: | 1285086736 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SETON MEDICAL MANAGMENT- THE CANCER CENTER AT PROVIDENCE PARK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6701 AIRPORT BLVD BLDG BT-101 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366086705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516331890 | ||||||||
| FaxNumber: | 2516331182 | ||||||||
| Practice Location | |||||||||
| Address1: | 6701 AIRPORT BLVD BLDG BT-101 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366086705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516331890 | ||||||||
| FaxNumber: | 2516331182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2016 | ||||||||
| LastUpdateDate: | 07/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | SELTZER | ||||||||
| AuthorizedOfficialFirstName: | MARJORIE | ||||||||
| AuthorizedOfficialMiddleName: | LEAH | ||||||||
| AuthorizedOfficialTitleorPosition: | PATIENT NAVIGATOR | ||||||||
| AuthorizedOfficialTelephone: | 2516331884 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CRNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0203X | 1-129322 | AL | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology, Radiation |
No ID Information.