Provider Demographics
NPI:1710021159
Name:CANCER CARE NETWORK OF SO TX - BOERNE
Entity Type:Organization
Organization Name:CANCER CARE NETWORK OF SO TX - BOERNE
Other - Org Name:HEMATOLOGY ONCOLOGY ASSOCIATES OF SO. TX.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-595-5326
Mailing Address - Street 1:4411 MEDICAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3832
Mailing Address - Country:US
Mailing Address - Phone:210-595-5326
Mailing Address - Fax:210-614-8740
Practice Address - Street 1:124 E BANDERA RD STE 301
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2852
Practice Address - Country:US
Practice Address - Phone:210-595-5326
Practice Address - Fax:210-614-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU4006Medicare ID - Type UnspecifiedGROUP MEDICARE