Provider Demographics
NPI:1437399557
Name:SITUS CANCER RESEARCH CENTER
Entity Type:Organization
Organization Name:SITUS CANCER RESEARCH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOLT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:479-636-0500
Mailing Address - Street 1:504 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3432
Mailing Address - Country:US
Mailing Address - Phone:479-636-0500
Mailing Address - Fax:479-636-6161
Practice Address - Street 1:504 N 13TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3432
Practice Address - Country:US
Practice Address - Phone:479-636-0500
Practice Address - Fax:479-636-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No251V00000XAgenciesVoluntary or Charitable