Provider Demographics
NPI:1902228596
Name:RADIATION THERAPY SPECIALIST OF ABILENE LLC
Entity Type:Organization
Organization Name:RADIATION THERAPY SPECIALIST OF ABILENE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-564-3643
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75710-0938
Mailing Address - Country:US
Mailing Address - Phone:877-839-9517
Mailing Address - Fax:903-531-2337
Practice Address - Street 1:2000 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2434
Practice Address - Country:US
Practice Address - Phone:325-670-6340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty