Provider Demographics
NPI:1841605995
Name:CAPE FEAR VALLEY HEALTH SYSTEM SPECIALTY GROUP, LLC
Entity Type:Organization
Organization Name:CAPE FEAR VALLEY HEALTH SYSTEM SPECIALTY GROUP, LLC
Other - Org Name:CAPE FEAR VALLEY CANCER CENTER AT HARNETT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-615-4000
Mailing Address - Street 1:1638 OWEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3424
Mailing Address - Country:US
Mailing Address - Phone:910-615-6910
Mailing Address - Fax:910-615-5626
Practice Address - Street 1:805 TILGHMAN DR STE C
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5883
Practice Address - Country:US
Practice Address - Phone:910-230-7800
Practice Address - Fax:910-615-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2347881Medicare PIN