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SOUTHERN CANCER CENTER PC NPI 1578629556


NPI Information

NPI: 1578629556
Provider Name: SOUTHERN CANCER CENTER, PC
Classification: Internal Medicine - 207RH0003X
Entity Type: Organization

Specialization: Hematology & Oncology

CLIA Number: 01D1047704

Address:
6701 AIRPORT BLVD
MOBILE, AL
ZIP 36608
Phone: (251) 625-6896
Get Directions

SOUTHERN CANCER CENTER, PC is a hematology and oncology internal medicine in Mobile, AL. 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. SOUTHERN CANCER CENTER, PC NPI is 1578629556. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

6701 AIRPORT BLVD
MOBILE, AL
ZIP 36608-705
Phone: (251) 625-6896
Fax: (251) 631-3209

The provider's authorized official is Lauren Pettis .
The authorized official title is Executive Director and has the following contact phone number (251) 625-6896.

The CLIA number assigned to this NPI record is 01D1047704 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 12/28/2006 and was last updated on 10/26/2021.


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
1207RX0202XInternal MedicineMedical OncologyNo
22085R0001XRadiologyRadiation OncologyNo
3207RH0003XInternal 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
1009941791MEDICAIDALABAMA
2009941794MEDICAIDALABAMA
3051558610OTHERALABAMAMEDICARE #
4213322MEDICAIDALABAMA
5P00377089OTHERALABAMARAILROAD MEDICARE
6009941793MEDICAIDALABAMA

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: 11/14/2023

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