Provider Demographics
NPI:1245279223
Name:CANCER CARE OF WNC
Entity type:Organization
Organization Name:CANCER CARE OF WNC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:V
Authorized Official - Last Name:BEAZLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-253-4262
Mailing Address - Street 1:21 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4550
Mailing Address - Country:US
Mailing Address - Phone:828-253-4262
Mailing Address - Fax:828-418-0926
Practice Address - Street 1:125 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-3035
Practice Address - Country:US
Practice Address - Phone:828-253-4262
Practice Address - Fax:828-252-9876
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANCER CARE OF WNC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906624Medicaid
NC02548OtherBLUE CROSS BLUE SHIELD NC
NC=========OtherTAX ID
NC2312008EMedicare PIN