1669874004 NPI number — VANTAGE CANCER CARE - ALABAMA, LLC

Table of content: GURJIT K KHURANA-HERSHEY M.D. (NPI 1235214016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669874004 NPI number — VANTAGE CANCER CARE - ALABAMA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VANTAGE CANCER CARE - ALABAMA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669874004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 ROSECRANS AVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
MANHATTAN BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90266-3763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-335-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29653 ANCHOR CROSS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAPHNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36526-9594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-626-1755
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
UDICIOUS
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, GENERAL COUNSEL
Authorized Official Telephone Number:
610-519-0550

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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