Basic Information
| Provider Information | |||||||||
| NPI: | 1326038258 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CANCER CARE OF WNC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 HOSPITAL DR | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282534262 | ||||||||
| FaxNumber: | 8284180926 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 HOSPITAL DR | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282534262 | ||||||||
| FaxNumber: | 8284180926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2005 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | BEAZLEY | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
| AuthorizedOfficialMiddleName: | V. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8282534262 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 2085R0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 02548 | 01 | NC | BLUE CROSS BLUE SHIELD OF | OTHER | 7902548 | 05 | NC | MEDICAID |