Provider Demographics
NPI:1164897963
Name:SIRI CANCER, BLOOD AND INFUSION CENTER
Entity Type:Organization
Organization Name:SIRI CANCER, BLOOD AND INFUSION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMOD
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-540-8430
Mailing Address - Street 1:2508 N MAIN ST STE G
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3266
Mailing Address - Country:US
Mailing Address - Phone:864-540-8430
Mailing Address - Fax:866-421-1896
Practice Address - Street 1:2508 N MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-540-8430
Practice Address - Fax:866-421-1896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty