Provider Demographics
NPI:1972553550
Name:HARRISBURG CANCER CENTER INC
Entity Type:Organization
Organization Name:HARRISBURG CANCER CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAZEK
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:618-252-5126
Mailing Address - Street 1:PO BOX 15040
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-0040
Mailing Address - Country:US
Mailing Address - Phone:812-476-1367
Mailing Address - Fax:812-477-4153
Practice Address - Street 1:20 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2453
Practice Address - Country:US
Practice Address - Phone:618-252-5126
Practice Address - Fax:618-252-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCN1378OtherRR MEDICARE
IL3300262019Medicaid
ILCN1378OtherRR MEDICARE