Provider Demographics
NPI:1841384138
Name:SOUTH ALABAMA RADIATION ONCOLOGY, PC
Entity Type:Organization
Organization Name:SOUTH ALABAMA RADIATION ONCOLOGY, PC
Other - Org Name:GULF COAST CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:HIXSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-943-1680
Mailing Address - Street 1:PO BOX 1380
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36536
Mailing Address - Country:US
Mailing Address - Phone:251-626-1755
Mailing Address - Fax:251-626-1755
Practice Address - Street 1:1703 N BUNNER ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2229
Practice Address - Country:US
Practice Address - Phone:251-626-1755
Practice Address - Fax:251-980-1683
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH ALABAMA RADIATION ONCOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01D1068466OtherCLIA
ALCC3256OtherRR MEDICARE
AL51524757OtherBCBS
AL529601710Medicaid
ALE464Medicare PIN