Basic Information
| Provider Information | |||||||||
| NPI: | 1700066255 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS ONCOLOGY CARE, PLLC | ||||||||
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| OtherOrganizationName: | GREGORY A. ECHT, MD P.A. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7415 LAS COLINAS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750637569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143792700 | ||||||||
| FaxNumber: | 9728693875 | ||||||||
| Practice Location | |||||||||
| Address1: | 2010 BEN MERRITT DR UNIT A | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762343853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9406262300 | ||||||||
| FaxNumber: | 9406262315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2007 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | NIETO | ||||||||
| AuthorizedOfficialFirstName: | CARMEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 2143792731 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TEXAS ONCOLOGY CARE, PLLC | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QX0203X | N | Ambulatory Health Care Facilities | Clinic/Center | Oncology, Radiation | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 1934143-01 | 05 | TX | MEDICAID | 1934143-04 | 05 | TX | MEDICAID |