Healthcare Provider Details

I. General information

NPI: 1437399557
Provider Name (Legal Business Name): SITUS CANCER RESEARCH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N 13TH ST
ROGERS AR
72756-3432
US

IV. Provider business mailing address

504 N 13TH ST
ROGERS AR
72756-3432
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-0500
  • Fax: 479-636-6161
Mailing address:
  • Phone: 479-636-0500
  • Fax: 479-636-6161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. J W BOLT
Title or Position: OPERATIONS MANAGER
Credential: PHD
Phone: 479-636-0500