Provider Demographics
NPI:1366499683
Name:SOUTH EAST TEXAS CANCER CENTER
Entity Type:Organization
Organization Name:SOUTH EAST TEXAS CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-490-2910
Mailing Address - Street 1:PO BOX 911223
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1223
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:690 N 14TH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1449
Practice Address - Country:US
Practice Address - Phone:409-899-7181
Practice Address - Fax:409-899-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, RadiationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079695501Medicaid
TX0034MAOtherBLUE CROSS BLUD SHIELD
TX079695501Medicaid
TX0034MAOtherBLUE CROSS BLUD SHIELD