Healthcare Provider Details

I. General information

NPI: 1073567111
Provider Name (Legal Business Name): BLOOD AND CANCER CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E DR HICKS BLVD
FLORENCE AL
35630-5768
US

IV. Provider business mailing address

202 E DR HICKS BLVD
FLORENCE AL
35630-5768
US

V. Phone/Fax

Practice location:
  • Phone: 256-760-0422
  • Fax: 256-760-0332
Mailing address:
  • Phone: 256-760-0422
  • Fax: 256-760-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberAL14483
License Number StateAL

VIII. Authorized Official

Name: DR. ANTHONY J KALLIATH
Title or Position: OWNER
Credential:
Phone: 256-760-0422