Healthcare Provider Details

I. General information

NPI: 1265710594
Provider Name (Legal Business Name): NORTHPOINT RADIATION CENTER GP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7718 LOUIS PASTEUR CT
SAN ANTONIO TX
78229-3442
US

IV. Provider business mailing address

PO BOX 678083
DALLAS TX
75267-8083
US

V. Phone/Fax

Practice location:
  • Phone: 210-477-9060
  • Fax: 210-477-9065
Mailing address:
  • Phone: 512-583-0205
  • Fax: 512-583-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License NumberR06604
License Number StateTX

VIII. Authorized Official

Name: DAVE DICKEY
Title or Position: CFO
Credential:
Phone: 972-573-4611