1891864377 NPI number — SOUTHEAST CANCER NETWORK, INC

Table of content: (NPI 1891864377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891864377 NPI number — SOUTHEAST CANCER NETWORK, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEAST CANCER NETWORK, INC
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:
COOSA VALLEY REGIONAL CANCER CENTER
Provider Other Organization Name Type Code:
5
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:
1891864377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 AFFLINK PL STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35406-2289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-366-9740
Provider Business Mailing Address Fax Number:
205-344-9992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
291 JAMES PAYTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLACAUGA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35150-8047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-245-0297
Provider Business Practice Location Address Fax Number:
256-245-0624
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
205-366-9740

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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