Provider Demographics
NPI:1972839074
Name:REGIONAL CANCER CARE
Entity Type:Organization
Organization Name:REGIONAL CANCER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-829-4450
Mailing Address - Street 1:PO BOX 601114
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1107 S FIFTH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9597
Practice Address - Country:US
Practice Address - Phone:919-563-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908206Medicaid
NC5908206Medicaid