Provider Demographics
NPI:1902280639
Name:TULCA CANCER INSTITUTE, PLLC
Entity Type:Organization
Organization Name:TULCA CANCER INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARON
Authorized Official - Middle Name:G
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-505-3200
Mailing Address - Street 1:901 N STRONG BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4206
Mailing Address - Country:US
Mailing Address - Phone:918-426-0625
Mailing Address - Fax:918-423-0695
Practice Address - Street 1:901 N STRONG BLVD
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4206
Practice Address - Country:US
Practice Address - Phone:918-426-0625
Practice Address - Fax:918-423-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200412430AMedicaid
OKOKAAA2559Medicare PIN