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CANCER CARE NETWORK OF SOUTH TEXAS PA NPI 1528176062


NPI Information

NPI: 1528176062
Provider Name: CANCER CARE NETWORK OF SOUTH TEXAS PA

Other Name: METROPOLITAN - S.A.TUMOR & BLOOD

Classification: Internal Medicine - 207RH0003X
Entity Type: Organization

Specialization: Hematology & Oncology

CLIA Number: 45D2080294

Address:
1200 BROOKLYN AVE
SUITE#115
SAN ANTONIO, TX
ZIP 78212
Phone: (210) 242-6531
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CANCER CARE NETWORK OF SOUTH TEXAS PA is a hematology and oncology internal medicine in San Antonio, TX. The provider is an internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. CANCER CARE NETWORK OF SOUTH TEXAS PA NPI is 1528176062. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Metropolitan - S.a.tumor & Blood.

The provider's business location address is:

1200 BROOKLYN AVE
SUITE#115
SAN ANTONIO, TX
ZIP 78212-803
Phone: (210) 242-6531
Fax: (210) 226-0402

The provider's authorized official is David H Gordon .
The authorized official title is President and has the following contact phone number (210) 545-6972.

The CLIA number assigned to this NPI record is 45D2080294 - ancillary testing site in health care center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/25/2006 and was last updated on 5/26/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RH0003XInternal MedicineHematology & OncologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1=========OTHERTEXASTAX ID
2109514302MEDICAIDTEXAS
300U40QOTHERTEXASBLURCROSS/BLUESHIELD TX
400U40QMEDICARE ID-TYPE UNSPECIFIEDTEXAS
5X05189MEDICARE UPINTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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