Provider Demographics
NPI:1134372030
Name:CEDAR PARK ONCOLOGY CLINIC
Entity type:Organization
Organization Name:CEDAR PARK ONCOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBRAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-526-5353
Mailing Address - Street 1:2207 S CLEAR CREEK RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4132
Mailing Address - Country:US
Mailing Address - Phone:254-526-5353
Mailing Address - Fax:254-554-5298
Practice Address - Street 1:921 W NEW HOPE DR
Practice Address - Street 2:SUITE 702
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6778
Practice Address - Country:US
Practice Address - Phone:512-986-4036
Practice Address - Fax:512-986-4596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEMPLE CANCER CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4724207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S4240OtherBCBS TX PROVIDER NUMBER
TX00271ZMedicare PIN
TX8S4240OtherBCBS TX PROVIDER NUMBER