Provider Demographics
NPI:1689788911
Name:OTERO COMMUNITY CANCER CENTER
Entity Type:Organization
Organization Name:OTERO COMMUNITY CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOREC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-437-8126
Mailing Address - Street 1:2559 MEDICAL DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8703
Mailing Address - Country:US
Mailing Address - Phone:575-437-8126
Mailing Address - Fax:575-431-8205
Practice Address - Street 1:2559 MEDICAL DR
Practice Address - Street 2:SUITE G
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8703
Practice Address - Country:US
Practice Address - Phone:575-437-8126
Practice Address - Fax:575-431-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00215961OtherRR MEDICARE PIN
NMP00215961OtherRR MEDICARE PIN
NMB93426Medicare UPIN