Provider Demographics
NPI:1295809978
Name:RADIATION ONCOLOGY ASSOCIATES OF GULF COAST, L.L.P.
Entity type:Organization
Organization Name:RADIATION ONCOLOGY ASSOCIATES OF GULF COAST, L.L.P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:LING
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,PHD
Authorized Official - Phone:361-576-9812
Mailing Address - Street 1:1502 E RED RIVER ST
Mailing Address - Street 2:#330
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5523
Mailing Address - Country:US
Mailing Address - Phone:361-576-9812
Mailing Address - Fax:361-574-1580
Practice Address - Street 1:1400 HIGHWAY 59 LOOP N
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-7807
Practice Address - Country:US
Practice Address - Phone:361-576-9812
Practice Address - Fax:361-574-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538248695OtherKARL K. CHEN, M.D., NPI
TXE21013OtherKARL K. CHEN, MD, UPIN
1093894198OtherDAVID L. JANSSEN, M.D., NPI
TX00K53DOtherBLUE CROSS BLUE SHIELD
TX083512601Medicaid
TXA13659OtherDAVID L JANSEN, MD, UPIN
TX=========OtherEIN
TX=========OtherEIN