Healthcare Provider Details

I. General information

NPI: 1396701546
Provider Name (Legal Business Name): NORTH STATE CANCER SPECIALTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 AIRPARK DR SUITE 103
REDDING CA
96001
US

IV. Provider business mailing address

PO BOX 496084
REDDING CA
96049-6084
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-8822
  • Fax: 530-242-0849
Mailing address:
  • Phone: 530-241-0473
  • Fax: 530-241-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35-056102F
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG73860
License Number StateCA

VIII. Authorized Official

Name: JED L FREEMAN
Title or Position: PRES
Credential: MD
Phone: 530-242-8822