Provider Demographics
NPI:1265526552
Name:GULF COAST CANCER CENTER
Entity type:Organization
Organization Name:GULF COAST CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:HIXSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-943-1680
Mailing Address - Street 1:PO BOX 1380
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36536
Mailing Address - Country:US
Mailing Address - Phone:251-948-7897
Mailing Address - Fax:251-968-8597
Practice Address - Street 1:253 PROFESSIONAL LANE
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542
Practice Address - Country:US
Practice Address - Phone:251-948-7897
Practice Address - Fax:251-968-8597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDE8138OtherRR MEDICARE
ALK771Medicare PIN