Healthcare Provider Details

I. General information

NPI: 1801889431
Provider Name (Legal Business Name): REGIONAL CANCER TREATMENT CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N MAGDALEN ST SUITE 120
SAN ANGELO TX
76903-5400
US

IV. Provider business mailing address

102 N MAGDALEN ST SUITE 120
SAN ANGELO TX
76903-5400
US

V. Phone/Fax

Practice location:
  • Phone: 325-653-2010
  • Fax: 325-658-8583
Mailing address:
  • Phone: 325-653-2010
  • Fax: 325-658-8583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISTY SONNENBERG
Title or Position: MANAGER
Credential:
Phone: 325-653-2010