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General NPI Number Information
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NPI Number | 1598768632
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Entity Type | Organization
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Legal Business Name | NORTHWEST OUTPATIENT CANCER CENTER
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 17323 RED OAK DR
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City | HOUSTON
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State | TX
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Zip | 77090-1243
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Country | US
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Telephone | 281-440-5006
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Fax | 281-440-6149
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Provider Business Mailing Address
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Address Line | P.O. BOX 4356, DEPT 664
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City | HOUSTON
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State | TX
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Zip | 77210-4356
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Country | US
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Telephone | 281-440-5006
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Fax | 281-440-6149
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MIRTHA T CASIMIR I
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Credential | M.D.
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Telephone | 281-440-5006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | F5854
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License Number State | TX
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