Provider Demographics
NPI:1699139915
Name:CUTANEOUS ONCOLOGY & SURGERY CENTER, LLC
Entity type:Organization
Organization Name:CUTANEOUS ONCOLOGY & SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-977-9876
Mailing Address - Street 1:1940 STONEGATE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HLS
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2541
Mailing Address - Country:US
Mailing Address - Phone:205-968-3919
Mailing Address - Fax:205-968-3918
Practice Address - Street 1:1940 STONEGATE DR STE 140
Practice Address - Street 2:
Practice Address - City:VESTAVIA HLS
Practice Address - State:AL
Practice Address - Zip Code:35242-2541
Practice Address - Country:US
Practice Address - Phone:205-968-3919
Practice Address - Fax:205-968-3918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL014-348OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL01C0001056OtherCMS CCN
ALU3714OtherSTATE LICENSE