Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 11/08/2008
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 EAST HIGHWAY 71
BASTROP TX
78602-5156
US

IV. Provider business mailing address

PO BOX 842374
DALLAS TX
75284-2374
US

V. Phone/Fax

Practice location:
  • Phone: 512-321-5700
  • Fax: 512-396-7640
Mailing address:
  • Phone: 512-583-0205
  • Fax: 512-583-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberH3082
License Number StateTX

VIII. Authorized Official

Name: DAVID C JONES
Title or Position: OWNER
Credential: MD
Phone: 512-396-2500