Provider Demographics
NPI:1487683041
Name:CANCER CARE CENTER, INC.
Entity type:Organization
Organization Name:CANCER CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AFTAB
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-945-4000
Mailing Address - Street 1:2210 GREEN VALLEY RD
Mailing Address - Street 2:STE 1
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2210 GREEN VALLEY RD STE 1
Practice Address - Street 2:STE1
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4648
Practice Address - Country:US
Practice Address - Phone:812-945-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003500A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100116760Medicaid
KY65926412Medicaid
KY65926412Medicaid
IN209100Medicare PIN
IN100116760Medicaid
KY00389Medicare ID - Type Unspecified
IN731040Medicare ID - Type Unspecified
IN243690Medicare ID - Type Unspecified