Basic Information
| Provider Information | |||||||||
| NPI: | 1730475062 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CANCER STRATEGIES INSTITUTE, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7415 LAS COLINAS BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750637568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143792700 | ||||||||
| FaxNumber: | 9728693875 | ||||||||
| Practice Location | |||||||||
| Address1: | 7415 LAS COLINAS BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750637568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143792700 | ||||||||
| FaxNumber: | 2143792750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2011 | ||||||||
| LastUpdateDate: | 06/24/2011 | ||||||||
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| AuthorizedOfficialLastName: | ECHT | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | ALLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2143792700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | H6809 | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 193414303 | 05 | TX | MEDICAID | 00W667 | 01 | TX | MEDICARE PTAN | OTHER |