=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548567704
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MD ANDERSON CANCER CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2011
-----------------------------------------------------
Last Update Date | 02/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 HOLCOMBE BLVD UNIT 1445
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-745-0496
-----------------------------------------------------
Fax | 713-794-4662
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1515 HOLCOMBE BLVD UNIT 1445
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-745-0496
-----------------------------------------------------
Fax | 713-794-4662
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN ASSISTANT
-----------------------------------------------------
Name | ASHIMA GOYAL
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 713-745-0496
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | PA06977
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------