Provider Demographics
NPI:1992182703
Name:BRACHYTHERAPY CENTERS OF TEXAS LLC
Entity Type:Organization
Organization Name:BRACHYTHERAPY CENTERS OF TEXAS LLC
Other - Org Name:BC OF TX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:972-403-9777
Mailing Address - Street 1:PO BOX 678799
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8799
Mailing Address - Country:US
Mailing Address - Phone:972-403-9777
Mailing Address - Fax:972-403-9222
Practice Address - Street 1:6513 PRESTON RD
Practice Address - Street 2:SUITE #300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2688
Practice Address - Country:US
Practice Address - Phone:972-403-9777
Practice Address - Fax:972-403-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2085R0001X, 261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty