Provider Demographics
NPI:1295744803
Name:CANCER CENTER ASSOCIATES
Entity type:Organization
Organization Name:CANCER CENTER ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-548-9690
Mailing Address - Street 1:4201 MEDICAL CENTER DR
Mailing Address - Street 2:# 180
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1764
Mailing Address - Country:US
Mailing Address - Phone:972-548-9690
Mailing Address - Fax:972-542-7715
Practice Address - Street 1:4201 MEDICAL CENTER DR
Practice Address - Street 2:# 180
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1764
Practice Address - Country:US
Practice Address - Phone:972-548-9690
Practice Address - Fax:972-542-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083503501Medicaid
TXDA7312OtherRAILROAD MEDICARE
TXCU0755OtherRAILROAD MEDICARE
TX00741TMedicare PIN
TXDA7312OtherRAILROAD MEDICARE
TX0385910001Medicare NSC