Provider Demographics
NPI:1700884822
Name:ATHENS CANCER CENTER LP
Entity Type:Organization
Organization Name:ATHENS CANCER CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:DIXON
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-677-8300
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-0326
Mailing Address - Country:US
Mailing Address - Phone:903-677-8300
Mailing Address - Fax:903-677-8354
Practice Address - Street 1:1801 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-5605
Practice Address - Country:US
Practice Address - Phone:903-677-8300
Practice Address - Fax:903-677-8354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR242122085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0023C2OtherBLUE CROSS
TX00223KMedicare ID - Type Unspecified