Provider Demographics
NPI:1508926080
Name:CANCER SPECIALISTS OF SO TX
Entity Type:Organization
Organization Name:CANCER SPECIALISTS OF SO TX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-993-3456
Mailing Address - Street 1:1625 RODD FIELD RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4926
Mailing Address - Country:US
Mailing Address - Phone:361-993-3456
Mailing Address - Fax:
Practice Address - Street 1:1625 RODD FIELD RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4926
Practice Address - Country:US
Practice Address - Phone:361-993-3456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7369174400000X, 207RH0003X
TXG8931174400000X
TXL9212174400000X
TXM1217174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX787700OtherFIRST HEALTH
TXP00150979OtherRAILROAD MEDICARE DR GONZ
TX231964795OtherTRICARE PRIME DR NASH
TX133216505Medicaid
TXP00288207OtherDR MAHMOOD RAILROAD MEDIC
TX152824210OtherTRICARE PRIME
TX830002865OtherDR NASH RAILROAD MEDICARE
TX166693501Medicaid
TX033804875OtherTRICARE PRIME
TX116419601Medicaid
TX6543177OtherCIGNA DR NASH
TX175676901Medicaid
TXC23727Medicare UPIN
TX8D8479Medicare ID - Type UnspecifiedDR MAHMOOD
TX152824210OtherTRICARE PRIME
TX86X863Medicare ID - Type UnspecifiedDR WOOD
TXP00150979OtherRAILROAD MEDICARE DR GONZ
TXF65899Medicare UPIN
TXP00288207OtherDR MAHMOOD RAILROAD MEDIC
TX116419601Medicaid