Provider Demographics
NPI:1831379361
Name:MUSKOGEE CANCER CLINIC INC PC
Entity type:Organization
Organization Name:MUSKOGEE CANCER CLINIC INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HANI
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:JUMEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD FRCP FACP
Authorized Official - Phone:918-686-8500
Mailing Address - Street 1:3206 W OKMULGEE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401
Mailing Address - Country:US
Mailing Address - Phone:918-686-8500
Mailing Address - Fax:918-686-8900
Practice Address - Street 1:3206 W OKMULGEE AVE
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401
Practice Address - Country:US
Practice Address - Phone:918-686-8500
Practice Address - Fax:918-686-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18238207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK393783545002OtherBCBS OF OK
OK393783545002OtherBCBS OF OK