Provider Demographics
NPI:1063647634
Name:CANCER HEALTH TREATMENT CENTERS, P.C.
Entity type:Organization
Organization Name:CANCER HEALTH TREATMENT CENTERS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-769-4855
Mailing Address - Street 1:8127 MERRILLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1485
Mailing Address - Country:US
Mailing Address - Phone:219-769-4855
Mailing Address - Fax:219-757-5629
Practice Address - Street 1:1630 45TH AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3963
Practice Address - Country:US
Practice Address - Phone:219-924-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANCER HEALTH TREATMENT CENTERS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100250100BMedicaid
IN5171410002Medicare NSC
218800Medicare PIN