Provider Demographics
NPI:1124407077
Name:KOTA CANCER CLINIC PLLC
Entity Type:Organization
Organization Name:KOTA CANCER CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MANJUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-463-5700
Mailing Address - Street 1:180 MEDICAL PARK PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 MEDICAL PARK PL
Practice Address - Street 2:SUITE 201
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8065
Practice Address - Country:US
Practice Address - Phone:501-463-5700
Practice Address - Fax:501-463-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology