Provider Demographics
NPI:1811274533
Name:KERRVILLE CANCER CENTER PLLC
Entity type:Organization
Organization Name:KERRVILLE CANCER CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALERIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHYLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:830-257-2070
Mailing Address - Street 1:218 SIDNEY BAKER ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5367
Mailing Address - Country:US
Mailing Address - Phone:830-257-2070
Mailing Address - Fax:830-896-7020
Practice Address - Street 1:218 SIDNEY BAKER ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5367
Practice Address - Country:US
Practice Address - Phone:830-257-2070
Practice Address - Fax:830-896-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty