Provider Demographics
NPI:1588770077
Name:CANCER CARE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:CANCER CARE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REDDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:REGANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-753-1220
Mailing Address - Street 1:1315 W AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1654
Mailing Address - Country:US
Mailing Address - Phone:319-768-3900
Mailing Address - Fax:
Practice Address - Street 1:1225 S GEAR AVE
Practice Address - Street 2:SUITE 152
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1691
Practice Address - Country:US
Practice Address - Phone:319-753-1220
Practice Address - Fax:319-753-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA229772085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4213017Medicaid
IA70081Medicare ID - Type Unspecified
B18029Medicare UPIN