Provider Demographics
NPI:1265628226
Name:CANCER CARE, PLC
Entity type:Organization
Organization Name:CANCER CARE, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIGAR
Authorized Official - Middle Name:KANUBHAI
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-802-8056
Mailing Address - Street 1:404 SAVANNAH TRACE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5442
Mailing Address - Country:US
Mailing Address - Phone:931-802-8056
Mailing Address - Fax:931-802-8059
Practice Address - Street 1:274 CLEAR SKY CT
Practice Address - Street 2:CLARKSVILLE CANCER CARE
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5653
Practice Address - Country:US
Practice Address - Phone:931-802-8056
Practice Address - Fax:931-802-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-23
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39642207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370182Medicare PIN