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General NPI Number Information
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NPI Number | 1396701546
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Entity Type | Organization
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Legal Business Name | NORTH STATE CANCER SPECIALTY INC
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 2510 AIRPARK DR SUITE 103
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City | REDDING
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State | CA
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Zip | 96001
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Country | US
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Telephone | 530-242-8822
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Fax | 530-242-0849
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Provider Business Mailing Address
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Address Line | PO BOX 496084
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City | REDDING
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State | CA
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Zip | 96049-6084
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Country | US
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Telephone | 530-241-0473
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Fax | 530-241-5377
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Authorized Official
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Title or Position | PRES
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Name | JED L FREEMAN
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Credential | MD
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Telephone | 530-242-8822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 35-056102F
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | G73860
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License Number State | CA
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