Provider Demographics
NPI:1003981341
Name:CANCER AND BLOOD SPECIALISTS OF TEXAS, PA
Entity Type:Organization
Organization Name:CANCER AND BLOOD SPECIALISTS OF TEXAS, PA
Other - Org Name:WACO REGIONAL CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BAOCHONG
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-752-2900
Mailing Address - Street 1:3420 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3130
Mailing Address - Country:US
Mailing Address - Phone:254-752-2900
Mailing Address - Fax:254-752-2902
Practice Address - Street 1:3420 PINE AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3130
Practice Address - Country:US
Practice Address - Phone:254-752-2900
Practice Address - Fax:254-752-2902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X, 207RH0003X, 261QR0200X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Not Answered291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1793838Medicaid
TX00620ZMedicare ID - Type Unspecified
TX1793838Medicaid