Provider Demographics
NPI:1073567111
Name:BLOOD AND CANCER CENTER, INC
Entity Type:Organization
Organization Name:BLOOD AND CANCER CENTER, INC
Other - Org Name:ANTHONY J KALLIATH MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KALLIATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-760-0422
Mailing Address - Street 1:202 E DR HICKS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5768
Mailing Address - Country:US
Mailing Address - Phone:256-760-0422
Mailing Address - Fax:256-760-0332
Practice Address - Street 1:202 E DR HICKS BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5768
Practice Address - Country:US
Practice Address - Phone:256-760-0422
Practice Address - Fax:256-760-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL14483332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
0133695OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AL051503257Medicaid
0133695OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AL4315870001Medicare NSC