Provider Demographics
NPI:1215187067
Name:CANCER CARE CENTER OF UNION CITY
Entity Type:Organization
Organization Name:CANCER CARE CENTER OF UNION CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:COOK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:731-668-1668
Mailing Address - Street 1:322 HOSPITAL BLVD.
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-668-1668
Mailing Address - Fax:731-668-5801
Practice Address - Street 1:1109 E REELFOOT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5856
Practice Address - Country:US
Practice Address - Phone:731-884-8611
Practice Address - Fax:731-884-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty