Provider Demographics
NPI:1134396450
Name:CHILDREN'S HEMATOLOGY & ONCOLOGY CENTER
Entity type:Organization
Organization Name:CHILDREN'S HEMATOLOGY & ONCOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NETWORK ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-616-0800
Mailing Address - Street 1:4499 MEDICAL DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3735
Mailing Address - Country:US
Mailing Address - Phone:210-616-0800
Mailing Address - Fax:210-616-0012
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:SUITE 260
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-616-0800
Practice Address - Fax:210-616-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG69562080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1126401-02OtherTPI
TX80X050OtherBC&BS
TX80X050OtherBC&BS