Provider Demographics
NPI:1932102597
Name:WALTER UMPHREY CANCER CENTER OF SOUTHEAST TEXAS
Entity Type:Organization
Organization Name:WALTER UMPHREY CANCER CENTER OF SOUTHEAST TEXAS
Other - Org Name:CANCER CENTER OF SOUTHEAST TEXAS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-982-9312
Mailing Address - Street 1:4600 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-5817
Mailing Address - Country:US
Mailing Address - Phone:409-982-9313
Mailing Address - Fax:409-982-5126
Practice Address - Street 1:4600 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5817
Practice Address - Country:US
Practice Address - Phone:409-982-9312
Practice Address - Fax:409-982-5126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00141ZMedicare PIN