Provider Demographics
NPI:1174755607
Name:JOURDANTON COMUNITY CANCER CENTER
Entity type:Organization
Organization Name:JOURDANTON COMUNITY CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HASSAAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-518-8036
Mailing Address - Street 1:1901 HIGHWAY 97 E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JOURDANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78026-1517
Mailing Address - Country:US
Mailing Address - Phone:830-769-3515
Mailing Address - Fax:
Practice Address - Street 1:1901 HIGHWAY 97 E
Practice Address - Street 2:SUITE 100
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-1517
Practice Address - Country:US
Practice Address - Phone:830-769-3515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty