Basic Information
| Provider Information | |||||||||
| NPI: | 1528072030 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY CANCER CENTER, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 242173 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381242173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018500272 | ||||||||
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| Practice Location | |||||||||
| Address1: | 271 W POLK AVE | ||||||||
| Address2: | |||||||||
| City: | WEST MEMPHIS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723014228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312878395 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 03/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | WEEKS | ||||||||
| AuthorizedOfficialFirstName: | ALBERT | ||||||||
| AuthorizedOfficialMiddleName: | EARLE | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9018500272 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 020435 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1336147263 | 01 | TN | ALBERT WEEKS-NPI | OTHER | 1548268592 | 01 | TN | SUHAIL OBAJI-NPI | OTHER |