Healthcare Provider Details

I. General information

NPI: 1245472356
Provider Name (Legal Business Name): SOUTHEAST CANCER NETWORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 TOWN CENTER DR SUITE MPS-6
ANNISTON AL
36205-4101
US

IV. Provider business mailing address

1400 AFFLINK PL SUITE 100
TUSCALOOSA AL
35406-2289
US

V. Phone/Fax

Practice location:
  • Phone: 256-847-3369
  • Fax: 256-847-3469
Mailing address:
  • Phone: 205-366-9740
  • Fax: 205-344-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE L MITCHELL
Title or Position: CFO
Credential:
Phone: 205-366-9740