Provider Demographics
NPI:1992710800
Name:FAMILY CANCER CENTER PLLC
Entity type:Organization
Organization Name:FAMILY CANCER CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-685-5655
Mailing Address - Street 1:PO BOX 242173
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38124-2173
Mailing Address - Country:US
Mailing Address - Phone:901-850-0272
Mailing Address - Fax:901-850-0782
Practice Address - Street 1:1012 S MILES AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261
Practice Address - Country:US
Practice Address - Phone:731-884-1412
Practice Address - Fax:731-884-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23524174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4035183OtherBCBS
TNCG9522OtherRRMCR
TN3723894Medicaid
AR135396002Medicaid
TNCG9522OtherRRMCR
TN3723894Medicare PIN