Provider Demographics
NPI:1508171968
Name:CANCER CARE NETWORK OF SOUTH TEXAS, PA
Entity Type:Organization
Organization Name:CANCER CARE NETWORK OF SOUTH TEXAS, PA
Other - Org Name:FLORESVILLE - HOAST
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-595-5300
Mailing Address - Street 1:100 NE LOOP 410
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4700
Mailing Address - Country:US
Mailing Address - Phone:210-242-6541
Mailing Address - Fax:210-212-5136
Practice Address - Street 1:497 10TH ST
Practice Address - Street 2:STE. 102
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3179
Practice Address - Country:US
Practice Address - Phone:210-595-5300
Practice Address - Fax:210-595-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109514302Medicaid
TX109514302Medicaid
TXCI2558Medicare PIN
TX00U40QMedicare PIN
TXCI4583Medicare PIN