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General NPI Number Information
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NPI Number | 1639575491
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Entity Type | Organization
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Legal Business Name | CANCER CARE GROUP PC
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 801 N STATE ST STE 50
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City | GREENFIELD
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State | IN
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Zip | 46140-1270
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Country | US
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Telephone | 317-325-2273
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Fax | 317-325-2777
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Provider Business Mailing Address
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Address Line | 6100 W 96TH ST STE 125
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-6005
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Country | US
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Telephone | 317-715-1800
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Fax | 317-715-6200
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Authorized Official
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Title or Position | CEO
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Name | STEPHEN A FREELAND
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Credential |
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Telephone | 317-715-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 50004183A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 50004183A
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License Number State | IN
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