Provider Demographics
NPI:1215012570
Name:TEXAS HEMATOLOGY/ONCOLOGY CENTER, PA
Entity Type:Organization
Organization Name:TEXAS HEMATOLOGY/ONCOLOGY CENTER, PA
Other - Org Name:TX HEMATOLOGY/ONCOLOGY CENTER-CARROLLTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:BIRENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-247-5510
Mailing Address - Street 1:10 MEDICAL PKWY
Mailing Address - Street 2:SUITE#106
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7840
Mailing Address - Country:US
Mailing Address - Phone:972-247-5510
Mailing Address - Fax:972-243-9178
Practice Address - Street 1:4352 NORTH JOSEY LANE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:972-395-1010
Practice Address - Fax:972-394-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24457OtherPHARMACY LICENSE#
TX4541618OtherNCPDP