Provider Demographics
NPI:1912946849
Name:CANCER CARE OF WNC, PA
Entity Type:Organization
Organization Name:CANCER CARE OF WNC, PA
Other - Org Name:CANCER CARE OF WNC, PA AT BREVARD
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:V
Authorized Official - Last Name:BEAZLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-253-4262
Mailing Address - Street 1:21 HOSPITAL DR
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4550
Mailing Address - Country:US
Mailing Address - Phone:828-253-4262
Mailing Address - Fax:828-418-0926
Practice Address - Street 1:70 NEELY ROAD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4267
Practice Address - Country:US
Practice Address - Phone:828-883-3987
Practice Address - Fax:828-884-8801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANCER CARE OF WNC, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34D0860245OtherCLIA
NC5906801Medicaid
NC02548OtherBLUE CROSS BLUE SHIELD NC
NC34D0860245OtherCLIA
NC34D0860245OtherCLIA