Provider Demographics
NPI:1689860207
Name:BLOOD & CANCER CENTER INC
Entity Type:Organization
Organization Name:BLOOD & CANCER CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTIZ ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-533-3040
Mailing Address - Street 1:3695A BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9009
Mailing Address - Country:US
Mailing Address - Phone:330-533-3040
Mailing Address - Fax:330-533-9459
Practice Address - Street 1:3695A BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9009
Practice Address - Country:US
Practice Address - Phone:330-533-3040
Practice Address - Fax:330-533-9459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH100427174400000X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0272164Medicaid
OH9927941OtherPTAN
OH1274590001Medicare NSC