Provider Demographics
NPI:1427187582
Name:CACHE VALLEY CANCER TREATMENT &RESEARCH CLINIC PC
Entity Type:Organization
Organization Name:CACHE VALLEY CANCER TREATMENT &RESEARCH CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEN-JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-752-5999
Mailing Address - Street 1:1281 N 600 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6988
Mailing Address - Country:US
Mailing Address - Phone:435-752-5999
Mailing Address - Fax:435-752-5551
Practice Address - Street 1:1281 N 600 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-6988
Practice Address - Country:US
Practice Address - Phone:435-752-5999
Practice Address - Fax:435-752-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT292373-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1427187582OtherGROUP NATIONAL PROVIDER IDENTIFIER
UT1427187582OtherGROUP NATIONAL PROVIDER IDENTIFIER