Provider Demographics
NPI:1689853038
Name:UNIVERSITY CANCER CENTER OF HUNTSVILLE BRENHAM INC
Entity Type:Organization
Organization Name:UNIVERSITY CANCER CENTER OF HUNTSVILLE BRENHAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:D'ANDREA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-579-0061
Mailing Address - Street 1:PO BOX 5575
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-5575
Mailing Address - Country:US
Mailing Address - Phone:281-579-0061
Mailing Address - Fax:281-579-0093
Practice Address - Street 1:521 INTERSTATE 45 S
Practice Address - Street 2:SUITE 10
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5650
Practice Address - Country:US
Practice Address - Phone:281-579-0061
Practice Address - Fax:281-579-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y285Medicare PIN