Provider Demographics
NPI:1295741924
Name:UNIVERSITY CANCER CENTER OF HUNTSVILLE BRENHAM INC
Entity type:Organization
Organization Name:UNIVERSITY CANCER CENTER OF HUNTSVILLE BRENHAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-579-0061
Mailing Address - Street 1:PO BOX 5575
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-5575
Mailing Address - Country:US
Mailing Address - Phone:281-579-0061
Mailing Address - Fax:281-579-0093
Practice Address - Street 1:605 MEDICAL CT
Practice Address - Street 2:SUITE 101
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5404
Practice Address - Country:US
Practice Address - Phone:281-579-0061
Practice Address - Fax:281-579-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5862261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation