=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245358183
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH TEXAS CANCER CENTER LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 10/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5948 W PARKER RD STE 200
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-7732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-378-4114
-----------------------------------------------------
Fax | 972-473-7204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5948 W PARKER RD STE 200
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-7732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-378-4114
-----------------------------------------------------
Fax | 972-473-7204
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | AMIR RANA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 940-387-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | K2566
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------