Provider Demographics
NPI:1669565586
Name:SOUTHWEST CANCER CENTER PA
Entity type:Organization
Organization Name:SOUTHWEST CANCER CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:E
Authorized Official - Last Name:VIVANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-351-7003
Mailing Address - Street 1:1501 N MESA
Mailing Address - Street 2:1A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-351-7003
Mailing Address - Fax:915-351-7738
Practice Address - Street 1:1501 N MESA
Practice Address - Street 2:1A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-351-7003
Practice Address - Fax:915-351-7738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty