MEDICARE: NORTHWEST OUTPATIENT CANCER CENTER

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	261QM2500X	Medical Specialty Clinic/Center	F5854	TX

General Provider Information

NPI Number	:	1598768632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST OUTPATIENT CANCER CENTER

Provider Business Mailing Address
First Line	:	P.O. BOX 4356, DEPT 664
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77210-4356
Country	:	US
Telephone Number	:	281-440-5006
Fax Number	:	281-440-6149

Provider Business Practice Location Address
First Line	:	17323 RED OAK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-1243
Country	:	US
Telephone Number	:	281-440-5006
Fax Number	:	281-440-6149

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MIRTHA T CASIMIR I
Credential	:	M.D.
Telephone Number	:	281-440-5006

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	05/20/2010

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