1386112092 NPI number — CANCER TREATMENT SPECIALIST, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386112092 NPI number — CANCER TREATMENT SPECIALIST, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANCER TREATMENT SPECIALIST, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386112092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 E MCCORMICK PKWY LOT 32
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85258-2912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-887-1114
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 MAUI LANI PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-442-5700
Provider Business Practice Location Address Fax Number:
808-442-5701
Provider Enumeration Date:
11/12/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BEECH
Authorized Official First Name:
DERRICK
Authorized Official Middle Name:
JEROME
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
615-887-1114

Provider Taxonomy Codes

  • Taxonomy code: 2086X0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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