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
1	207RH0000X	Hematology (Internal Medicine) Physician
2	207RX0202X	Medical Oncology Physician
3	207VX0201X	Gynecologic Oncology Physician
4	2085R0001X	Radiation Oncology Physician
5	207RH0003X	Hematology & Oncology Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1336390269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANCER CARE NETWORK OF SOUTH TEXAS PA

Provider Business Mailing Address
First Line	:	4411 MEDICAL DRIVE
Second Line	:	STE. 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3832
Country	:	US
Telephone Number	:	210-595-5300
Fax Number	:	210-595-5301

Provider Business Practice Location Address
First Line	:	4411 MEDICAL DRIVE
Second Line	:	STE. 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3832
Country	:	US
Telephone Number	:	210-595-5300
Fax Number	:	210-595-5301

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

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	05/26/2010

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

Language	Start Address	Practice Location

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