Provider Demographics
NPI:1548567704
Name:MD ANDERSON CANCER CENTER
Entity Type:Organization
Organization Name:MD ANDERSON CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ASHIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:713-745-0496
Mailing Address - Street 1:1515 HOLCOMBE BLVD
Mailing Address - Street 2:UNIT 1445
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4000
Mailing Address - Country:US
Mailing Address - Phone:713-745-0496
Mailing Address - Fax:713-794-4662
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:UNIT 1445
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-745-0496
Practice Address - Fax:713-794-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06977282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital