Provider Demographics
NPI:1760739098
Name:NORTH TEXAS SRS LLC
Entity Type:Organization
Organization Name:NORTH TEXAS SRS LLC
Other - Org Name:PREMIER CANCER CENTERS DALLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-954-7734
Mailing Address - Street 1:PO BOX 678099
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8099
Mailing Address - Country:US
Mailing Address - Phone:214-954-7734
Mailing Address - Fax:469-250-4299
Practice Address - Street 1:10425 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2208
Practice Address - Country:US
Practice Address - Phone:214-954-7734
Practice Address - Fax:469-250-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation