Provider Demographics
NPI:1760420491
Name:CENTRAL TEXAS ONCOLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:CENTRAL TEXAS ONCOLOGY ASSOCIATES, P.A.
Other - Org Name:SOUTHWEST REGIONAL CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-421-4117
Mailing Address - Street 1:PO BOX 911268
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1268
Mailing Address - Country:US
Mailing Address - Phone:512-419-9733
Mailing Address - Fax:512-454-4575
Practice Address - Street 1:901 W 38TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1165
Practice Address - Country:US
Practice Address - Phone:512-419-9733
Practice Address - Fax:512-451-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0811853-01Medicaid
TX0811853-01Medicaid