MEDICARE: CANCER CARE NETWORK OF SOUTH TEXAS 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	207RH0003X	Hematology & Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00U40Q	OTHER	TX	BCBS OF TX

General Provider Information

NPI Number	:	1316198443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANCER CARE NETWORK OF SOUTH TEXAS PA

Provider Business Mailing Address
First Line	:	1340 E WALNUT ST
Second Line	:	STE. 1348
City	:	SEGUIN
State	:	TX
Zip	:	78155-5126
Country	:	US
Telephone Number	:	830-643-1762
Fax Number	:	830-609-7702

Provider Business Practice Location Address
First Line	:	1340 E WALNUT ST
Second Line	:	STE. 1348
City	:	SEGUIN
State	:	TX
Zip	:	78155-5126
Country	:	US
Telephone Number	:	830-643-1762
Fax Number	:	830-609-7702

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROGER M LYONS
Credential	:	MD
Telephone Number	:	210-595-5300

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	05/26/2010

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Directions to “CANCER CARE NETWORK OF SOUTH TEXAS PA ” Practice Location

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