MEDICARE: WALTER UMPHREY CANCER CENTER OF SOUTHEAST TEXAS

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	174400000X	Specialist	H1872	TX

General Provider Information

NPI Number	:	1932102597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER UMPHREY CANCER CENTER OF SOUTHEAST TEXAS

Provider Business Mailing Address
First Line	:	4600 9TH AVE
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5817
Country	:	US
Telephone Number	:	409-982-9313
Fax Number	:	409-982-5126

Provider Business Practice Location Address
First Line	:	4600 9TH AVE
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5817
Country	:	US
Telephone Number	:	409-982-9312
Fax Number	:	409-982-5126

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. JACKIE C REED
Credential	:
Telephone Number	:	409-982-9312

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/07/2007

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