MEDICARE: BASTROP LOST PINES CENTER FOR CANCER CARE LTD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	H3082	TX

General Provider Information

NPI Number	:	1770737454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASTROP LOST PINES CENTER FOR CANCER CARE LTD

Provider Business Mailing Address
First Line	:	PO BOX 842374
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-2374
Country	:	US
Telephone Number	:	512-583-0205
Fax Number	:	512-583-2001

Provider Business Practice Location Address
First Line	:	3107 EAST HIGHWAY 71
Second Line	:
City	:	BASTROP
State	:	TX
Zip	:	78602-5156
Country	:	US
Telephone Number	:	512-321-5700
Fax Number	:	512-396-7640

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID C JONES
Credential	:	MD
Telephone Number	:	512-396-2500

Provider Enumeration Date	:	11/08/2008
Last Update Date	:	10/19/2010

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