1871639179 NPI number — ROWLETT REGIONAL CANCER CENTER PA

Table of content: (NPI 1871639179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871639179 NPI number — ROWLETT REGIONAL CANCER CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROWLETT REGIONAL CANCER CENTER PA
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:
1871639179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6300 BRIDGE POINT PKWY
Provider Second Line Business Mailing Address:
BLDG 2 STE 115
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78730-5073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-583-2000
Provider Business Mailing Address Fax Number:
512-583-2002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9500 LAKEVIEW PKWY
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
ROWLETT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75088-4557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-475-0960
Provider Business Practice Location Address Fax Number:
972-412-5219
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRADFIELD
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
574-315-8131

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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