=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831379361
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUSKOGEE CANCER CLINIC INC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2007
-----------------------------------------------------
Last Update Date | 11/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3206 W OKMULGEE AVE
-----------------------------------------------------
City | MUSKOGEE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-686-8500
-----------------------------------------------------
Fax | 918-686-8900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3206 W OKMULGEE AVE
-----------------------------------------------------
City | MUSKOGEE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-686-8500
-----------------------------------------------------
Fax | 918-686-8900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRESIDENT
-----------------------------------------------------
Name | HANI GEORGE JUMEAN
-----------------------------------------------------
Credential | MD FRCP FACP
-----------------------------------------------------
Telephone | 918-686-8500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 18238
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------