Provider Demographics
NPI:1215942982
Name:UNIVERSITY CANCER CENTER HUNTSVILLE/BRENHAM, INC.
Entity type:Organization
Organization Name:UNIVERSITY CANCER CENTER HUNTSVILLE/BRENHAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELKA
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPCH,COO
Authorized Official - Phone:972-394-5594
Mailing Address - Street 1:521 I-45
Mailing Address - Street 2:#10
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:521 I-45
Practice Address - Street 2:#10
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:972-395-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5862261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation