1770737454 NPI number — BASTROP LOST PINES CENTER FOR CANCER CARE LTD

Table of content: (NPI 1770737454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770737454 NPI number — BASTROP LOST PINES CENTER FOR CANCER CARE LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BASTROP LOST PINES CENTER FOR CANCER CARE LTD
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:
6
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:
1770737454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 842374
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-2374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-583-0205
Provider Business Mailing Address Fax Number:
512-583-2001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3107 EAST HIGHWAY 71
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BASTROP
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78602-5156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-321-5700
Provider Business Practice Location Address Fax Number:
512-396-7640
Provider Enumeration Date:
11/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
512-396-2500

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  H3082 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com