Basic Information
| Provider Information | |||||||||
| NPI: | 1639151905 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HILL COUNTRY CENTER FOR CANCER CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1008 | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786671008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8309904800 | ||||||||
| FaxNumber: | 8302573161 | ||||||||
| Practice Location | |||||||||
| Address1: | 753 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786245239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8309904800 | ||||||||
| FaxNumber: | 8302573161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 08/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | CAMPBELL | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8302573131 | ||||||||
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| 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 | 2085R0001X | H3082 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | DE5633 | 01 | TX | RR MEDICARE | OTHER | 178215301 | 05 | TX | MEDICAID |