SOUTHEAST CANCER NETWORK, INC.

Provider Demographics

• NPI: 1962459073
• Name: SOUTHEAST CANCER NETWORK, INC.
• Entity Type: Organization
• Organization Name: SOUTHEAST CANCER NETWORK, INC.
• Authorized Official - Title/Position: CFO
• Authorized Official - First Name: STEVE
• Authorized Official - Middle Name: L
• Authorized Official - Last Name: MITCHELL
• Authorized Official - Phone: 205-366-1605
• Mailing Address - Street 1: 1400 AFFLINK PL
• Mailing Address - Street 2: SUITE 100
• Mailing Address - City: TUSCALOOSA
• Mailing Address - State: AL
• Mailing Address - Zip Code: 35406-2289
• Mailing Address - Country: US
• Mailing Address - Phone: 205-366-9740
• Mailing Address - Fax: 205-344-9992
• Practice Address - Street 1: 1400 AFFLINK PL
• Practice Address - Street 2: SUITE 100
• Practice Address - City: TUSCALOOSA
• Practice Address - State: AL
• Practice Address - Zip Code: 35406-2289
• Practice Address - Country: US
• Practice Address - Phone: 205-366-9740
• Practice Address - Fax: 205-344-9992
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-27
• Last Update Date: 2014-03-05

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207RH0003X	Allopathic & Osteopathic Physicians	Internal Medicine	Hematology & Oncology	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
AL	CD7212	Other	RAILROAD MEDICARE GROUP PTAN
AL	5810150009	Medicare NSC
AL	3037418	Medicare ID - Type Unspecified	CIGNA MEDICARE PROVIDER N
AL	5810150006	Medicare NSC
AL	5810150007	Medicare NSC
AL	5810150008	Medicare NSC
AL	CD7212	Other	RAILROAD MEDICARE GROUP PTAN
AL	3373105	Medicare ID - Type Unspecified	CIGNA MEDICARE GROUP
AL	5810150004	Medicare NSC
AL	5810150003	Medicare NSC
AL	5810150001	Medicare NSC
AL	H715	Medicare ID - Type Unspecified	MEDICARE GROUP NUMBER
AL	5810150002	Medicare NSC
AL	G526	Medicare ID - Type Unspecified	GROUP NUMBER
AL	J216	Medicare ID - Type Unspecified	GROUP
AL	5810150005	Medicare NSC
AL	H448	Medicare ID - Type Unspecified	GROUP
AL	H649	Medicare ID - Type Unspecified	GROUP
AL	I938	Medicare ID - Type Unspecified	GROUP
AL	F924	Medicare ID - Type Unspecified	GROUP
TN	M340	Medicare ID - Type Unspecified	MEDICARE GROUP NUMBER
AL	5810150007	Medicare NSC
AL	3373105	Medicare ID - Type Unspecified	CIGNA MEDICARE GROUP
AL	F925	Medicare ID - Type Unspecified	GROUP
AL	F922	Medicare ID - Type Unspecified	GROUP