Provider Demographics
NPI:1275650434
Name:CANCER CARE CENTER OF HENRY COUNTY, LLC
Entity Type:Organization
Organization Name:CANCER CARE CENTER OF HENRY COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIN HARDIN
Authorized Official - Suffix:
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:38305-2079
Mailing Address - Country:US
Mailing Address - Phone:731-668-1668
Mailing Address - Fax:731-668-5801
Practice Address - Street 1:1290 KELLEY DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4745
Practice Address - Country:US
Practice Address - Phone:731-644-3522
Practice Address - Fax:731-644-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3720631Medicaid
TN3720631Medicaid