Provider Demographics
NPI:1053562181
Name:CANCER CARE NETWORK OF SOUTH TEXAS PA
Entity type:Organization
Organization Name:CANCER CARE NETWORK OF SOUTH TEXAS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-595-5300
Mailing Address - Street 1:124 E. BANDERA RD.
Mailing Address - Street 2:STE. 301
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2852
Mailing Address - Country:US
Mailing Address - Phone:830-249-1429
Mailing Address - Fax:830-249-1469
Practice Address - Street 1:124 E. BANDERA RD.
Practice Address - Street 2:STE. 301
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2852
Practice Address - Country:US
Practice Address - Phone:830-249-1429
Practice Address - Fax:830-249-1469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109514302Medicaid
TX00U40QOtherBCBS OF TX
TX00U40QMedicare PIN
TXX05189Medicare UPIN
TXCI4583Medicare PIN
TXCN2558Medicare PIN