Provider Demographics
NPI:1598102345
Name:LANDMARK CANCER CENTER GP LLC
Entity Type:Organization
Organization Name:LANDMARK CANCER CENTER GP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOOTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-573-4611
Mailing Address - Street 1:PO BOX 678015
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8015
Mailing Address - Country:US
Mailing Address - Phone:918-683-2000
Mailing Address - Fax:918-686-0554
Practice Address - Street 1:301 N 32ND ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2106
Practice Address - Country:US
Practice Address - Phone:918-683-2000
Practice Address - Fax:918-686-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK289692085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty