Provider Demographics
NPI:1598768632
Name:NORTHWEST OUTPATIENT CANCER CENTER
Entity Type:Organization
Organization Name:NORTHWEST OUTPATIENT CANCER CENTER
Other - Org Name:NORTHWEST CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRTHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASIMIR
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:281-440-5006
Mailing Address - Street 1:P.O. BOX 4356, DEPT 664
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4356
Mailing Address - Country:US
Mailing Address - Phone:281-440-5006
Mailing Address - Fax:281-440-6149
Practice Address - Street 1:17323 RED OAK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-1243
Practice Address - Country:US
Practice Address - Phone:281-440-5006
Practice Address - Fax:281-440-6149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5854261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D29CMedicare PIN
TX0533800001Medicare NSC
TX1598768632Medicare PIN