Provider Demographics
NPI:1003327362
Name:ALICE CANCER CARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:ALICE CANCER CARE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GHRAOWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-453-4117
Mailing Address - Street 1:2520 E MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4188
Mailing Address - Country:US
Mailing Address - Phone:361-453-4117
Mailing Address - Fax:361-453-4218
Practice Address - Street 1:2520 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4188
Practice Address - Country:US
Practice Address - Phone:361-453-4117
Practice Address - Fax:361-453-4218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6958207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty