Provider Demographics
NPI:1689624264
Name:CANCER HEALTH TREATMENT CENTERS, P.C.
Entity Type:Organization
Organization Name:CANCER HEALTH TREATMENT CENTERS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-310-2550
Mailing Address - Street 1:342 E 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8693
Mailing Address - Country:US
Mailing Address - Phone:219-310-2550
Mailing Address - Fax:219-310-2565
Practice Address - Street 1:342 E 109TH AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8693
Practice Address - Country:US
Practice Address - Phone:219-310-2550
Practice Address - Fax:219-310-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100250100Medicaid
IN5171410004Medicare NSC
IN5171410002Medicare NSC
IN5171410001Medicare NSC
IN5171410003Medicare NSC
IN218800Medicare PIN
IN100250100Medicaid