MEDICARE: SOUTHERN CANCER CENTER, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	208600000X	Surgery Physician
2	2086X0206X	Surgical Oncology Physician
3	207RX0202X	Medical Oncology Physician
4	332900000X	Non-Pharmacy Dispensing Site
5	2085R0001X	Radiation Oncology Physician
6	207RH0003X	Hematology & Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578629556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN CANCER CENTER, PC

Provider Business Mailing Address
First Line	:	29653 ANCHOR CROSS BLVD
Second Line	:
City	:	DAPHNE
State	:	AL
Zip	:	36526-9594
Country	:	US
Telephone Number	:	251-625-6896
Fax Number	:	251-625-6897

Provider Business Practice Location Address
First Line	:	6701 AIRPORT BLVD
Second Line	:	B BLDG., T LEVEL
City	:	MOBILE
State	:	AL
Zip	:	36608-6705
Country	:	US
Telephone Number	:	251-625-6896
Fax Number	:	251-266-3209

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LAUREN PETTIS
Credential	:	RN/OCN
Telephone Number	:	251-625-6896

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	12/16/2025

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Directions to “SOUTHERN CANCER CENTER, PC ” Practice Location

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