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General NPI Number Information
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NPI Number | 1073567111
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Entity Type | Organization
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Legal Business Name | BLOOD AND CANCER CENTER, INC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 202 E DR HICKS BLVD
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City | FLORENCE
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State | AL
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Zip | 35630-5768
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Country | US
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Telephone | 256-760-0422
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Fax | 256-760-0332
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Provider Business Mailing Address
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Address Line | 202 E DR HICKS BLVD
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City | FLORENCE
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State | AL
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Zip | 35630-5768
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Country | US
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Telephone | 256-760-0422
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Fax | 256-760-0332
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY J KALLIATH
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Credential |
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Telephone | 256-760-0422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | AL14483
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License Number State | AL
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