Provider Demographics
NPI:1760403703
Name:NORTHWEST ALABAMA CANCER CENTER PC
Entity Type:Organization
Organization Name:NORTHWEST ALABAMA CANCER CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-381-1001
Mailing Address - Street 1:101 DR W H BLAKE JR DR
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2152
Mailing Address - Country:US
Mailing Address - Phone:256-381-1001
Mailing Address - Fax:256-381-3604
Practice Address - Street 1:101 DR W H BLAKE JR DR
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2152
Practice Address - Country:US
Practice Address - Phone:256-381-1001
Practice Address - Fax:256-381-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q70886Medicare UPIN
F876Medicare PIN
E68321Medicare UPIN
G563Medicare PIN
ALC34102Medicare UPIN
H44960Medicare UPIN