Provider Demographics
NPI:1659578219
Name:BERRIEN COUNTY CANCER SERVICE INC
Entity Type:Organization
Organization Name:BERRIEN COUNTY CANCER SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:269-429-3281
Mailing Address - Street 1:7301 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127
Mailing Address - Country:US
Mailing Address - Phone:269-429-3281
Mailing Address - Fax:269-429-3281
Practice Address - Street 1:7301 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127
Practice Address - Country:US
Practice Address - Phone:269-429-3281
Practice Address - Fax:269-429-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0240260001Medicare NSC