Provider Demographics
NPI:1801889431
Name:REGIONAL CANCER TREATMENT CENTER LTD
Entity type:Organization
Organization Name:REGIONAL CANCER TREATMENT CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SONNENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-653-2010
Mailing Address - Street 1:102 N MAGDALEN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-5400
Mailing Address - Country:US
Mailing Address - Phone:325-653-2010
Mailing Address - Fax:325-658-8583
Practice Address - Street 1:102 N MAGDALEN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5400
Practice Address - Country:US
Practice Address - Phone:325-653-2010
Practice Address - Fax:325-658-8583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109435102Medicaid
TX00D950Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER