Provider Demographics
NPI:1659690097
Name:CANCER CENTER ASSOCIATES
Entity Type:Organization
Organization Name:CANCER CENTER ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-424-3613
Mailing Address - Street 1:2540 N GALLOWAY AVE
Mailing Address - Street 2:304
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6306
Mailing Address - Country:US
Mailing Address - Phone:214-424-3613
Mailing Address - Fax:214-905-7550
Practice Address - Street 1:4325 JOSEY LANE
Practice Address - Street 2:SUITE 301
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:214-905-1300
Practice Address - Fax:214-905-7550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANCER CENTER ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-25
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083503501Medicaid
TX0385910003Medicare NSC
TX00741TMedicare PIN