Provider Demographics
NPI:1326001462
Name:SCOTT & WHITE CENTER FOR CANCER PREVENTION AND CARE
Entity Type:Organization
Organization Name:SCOTT & WHITE CENTER FOR CANCER PREVENTION AND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOC VICE PRESIDENT, RCO
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-215-9719
Mailing Address - Street 1:PO BOX 847408
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2207 S CLEAR CREEK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4132
Practice Address - Country:US
Practice Address - Phone:254-200-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C307OtherBLUE SHIELD
TX1496267-02Medicaid
TX1496267-01Medicaid
TX1496267-02Medicaid
TX1496267-02Medicaid