MEDICARE: TEXAS HEMATOLOGY/ONCOLOGY CENTER, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	24457	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24457	OTHER	TX	PHARMACY LICENSE#
2	4541618	OTHER	TX	NCPDP

General Provider Information

NPI Number	:	1215012570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS HEMATOLOGY/ONCOLOGY CENTER, PA

Provider Business Mailing Address
First Line	:	10 MEDICAL PKWY
Second Line	:	SUITE#106
City	:	DALLAS
State	:	TX
Zip	:	75234-7840
Country	:	US
Telephone Number	:	972-247-5510
Fax Number	:	972-243-9178

Provider Business Practice Location Address
First Line	:	4352 NORTH JOSEY LANE
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010
Country	:	US
Telephone Number	:	972-395-1010
Fax Number	:	972-394-5780

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DENNIS H BIRENBAUM
Credential	:	MD
Telephone Number	:	972-247-5510

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/22/2020

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