Basic Information
| Provider Information | |||||||||
| NPI: | 1902228596 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIATION THERAPY SPECIALIST OF ABILENE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 938 | ||||||||
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| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757100938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778399517 | ||||||||
| FaxNumber: | 9035312337 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 PINE ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796012434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256706340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2014 | ||||||||
| LastUpdateDate: | 04/09/2014 | ||||||||
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| AuthorizedOfficialLastName: | MAHONEY | ||||||||
| AuthorizedOfficialFirstName: | BRENT | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8045643643 | ||||||||
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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 | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.