SOUTHEAST CANCER NETWORK, INC (NPI# 1255400834) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255400834 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST CANCER NETWORK, INC |
| Other Organization Name | CANCER CARE CENTER OF MONTGOMERY SOUTH |
| Practice Address |
2055 E South Blvd Ste 202 Montgomery AL 36116-2001 |
| Mailing Address |
1400 Afflink Pl Ste 100 Tuscaloosa AL 35406-2289 |
| Practice Telephone | 3342817710 |
| Mailing Telephone | 2053669740 |
| Mailing Fax Number | 2053449992 |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | STEVE L MITCHELL (CFO) |
| Authorized Official Telephone | 2053669740 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians | ||
| X | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| CANCER CARE CENTER OF MONTGOMERY SOUTH | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609072537 | Southeast Cancer Network, Inc | Internal Medicine | 105 Highway 80 E., Demopolis, AL 36732 | 2007-06-26 |
| 1578633566 | Southeast Cancer Network, Inc | Internal Medicine | 2505 Us Hwy 431, Boaz, AL 35957 | 2006-11-08 |
| 1215007273 | Southeast Cancer Network, Inc | Internal Medicine | 3500 Hwy 78 East, Jasper, AL 35501 | 2006-11-08 |
| 1063581536 | Southeast Cancer Network, Inc | Internal Medicine | 171 Caraway Dr, Winfield, AL 35594-5067 | 2006-11-07 |
| 1790854255 | Southeast Cancer Network, Inc | Internal Medicine | 22281 Us Highway 72, Ste B, Athens, AL 35613-2600 | 2006-11-07 |
| 1013140904 | Southeast Cancer Network, Inc | Internal Medicine | 1758 Park Pl, Suite 301, Montgomery, AL 36106-1127 | 2009-08-26 |
| 1245472356 | Southeast Cancer Network, Inc | Internal Medicine | 171 Town Center Dr, Suite Mps-6, Anniston, AL 36205-4101 | 2009-04-03 |
| 1295807857 | Southeast Cancer Network, Inc | Internal Medicine | 1410 Mcfarland Blvd N, Tuscaloosa, AL 35406-2209 | 2006-11-15 |
| 1235208778 | Southeast Cancer Network, Inc | Internal Medicine | 1024 1st St N, Alabaster, AL 35007-8703 | 2006-11-07 |
| 1780753418 | Southeast Cancer Network, Inc | Internal Medicine | 300 Saint Lukes Dr, Montgomery, AL 36117-7102 | 2006-11-07 |
| Street Address |
2055 E SOUTH BLVD STE 202 |
| City | MONTGOMERY |
| State | AL |
| Zip Code | 36116-2001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891792412 | Darbi R Stevens | Nurse Practitioner | 2055 E South Blvd, 403, Montgomery, AL 36116-2001 | 2005-06-29 |
| 1235753849 | Nahyun Jo | Student in an Organized Health Care Education/Training Program | 2055 E South Blvd, Montgomery, AL 36116-2001 | 2020-05-31 |
| 1043839855 | Kenechukwu Hilary Ibeneme | Student in an Organized Health Care Education/Training Program | 2055 E South Blvd, Montgomery, AL 36116-2001 | 2020-04-11 |
| 1699300145 | Kelli Bryant | Nurse Practitioner | 2055 E South Blvd, Montgomery, AL 36116-2001 | 2020-03-05 |
| 1215455464 | Justin Johnnie Cook | Student in an Organized Health Care Education/Training Program | 2055 E South Blvd, Montgomery, AL 36116-2001 | 2017-09-07 |
| 1295261246 | Benjamin Chaucer | Internal Medicine | 2055 E South Blvd, Montgomery, AL 36116-2001 | 2017-05-11 |
| 1649705013 | Sindhura Talluri | Student in an Organized Health Care Education/Training Program | 2055 E South Blvd, Suite 200, Montgomery, AL 36116-2001 | 2017-04-24 |
| 1629502240 | Baptist Tower Pharmacy | General Acute Care Hospital | 2055 E South Blvd, Montgomery, AL 36116-2001 | 2017-04-20 |
| 1598299463 | Yoon Young Cho | Student in an Organized Health Care Education/Training Program | 2055 E South Blvd, Suite 200, Montgomery, AL 36116-2001 | 2017-04-17 |
| 1407380447 | Swetha Yenduru | Student in an Organized Health Care Education/Training Program | 2055 E South Blvd, Suite 200, Montgomery, AL 36116-2001 | 2017-04-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275153892 | Sayyeda Ann Uz Zahra | Student in an Organized Health Care Education/Training Program | 2055 East South Blvd. Suite 202, Uab Montgomery, Montgomery, AL 36116 | 2020-04-23 |
| 1861958241 | Tameka Lene' Myles | Nurse Practitioner | 2905 East South Boulevard, Montgomery, AL 36116 | 2019-02-11 |
| 1750869814 | Nina Yvette Massey | Family Medicine | Baptist South Uab Multi Specialty Clinic, 2119 E. South Blvd, Montgomery, AL 36116 | 2018-08-01 |
| 1336635697 | Briana Lynn Adair | Speech-Language Pathologist | 2185 Normandie Rd., Montgomery, AL 36116 | 2018-07-10 |
| 1790201770 | Rinka Ravi Pahwani | Student in an Organized Health Care Education/Training Program | 4371 Narrow Lane Road, Suite 100, Montgomery, AL 36116 | 2017-08-21 |
| 1982052015 | Kevin J Jones | Pharmacist | 4385 Narrow Lane Rd, Montgomery, AL 36116 | 2016-05-31 |
| 1891153284 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 8035 Vaughn Road, Montgomery, AL 36116 | 2016-02-01 |
| 1871917583 | E Dental | Dentist | 6956 Vaughn Rd, Montgomery, AL 36116 | 2014-02-17 |
| 1033545199 | Jennings Professional Services LLC | Home Health | 2921 Martin Lane, Montgomery, AL 36116 | 2013-09-20 |
| 1750721973 | Joseph Alan Taylor | Counselor | 8104 Seaton Place, Montgomery, AL 36116 | 2013-07-02 |
| Find all providers in zip 36116 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417222720 | The Health Care Authority for Baptist Health, An Affiliate of Uabhs | Internal Medicine | 4145 Carmichael Rd, Montgomery, AL 36106-2803 | 2012-03-20 |
| 1740578905 | Astrid Belalcazar | Internal Medicine | 300 Saint Lukes Dr, Montgomery, AL 36117-7102 | 2011-07-21 |
| 1013140904 | Southeast Cancer Network, Inc | Internal Medicine | 1758 Park Pl, Suite 301, Montgomery, AL 36106-1127 | 2009-08-26 |
| 1679786354 | John Edward Reardon | Internal Medicine | 4145 Carmichael Road, Montgomery Cancer Center, Montgomery, AL 36106-2803 | 2007-05-08 |
| 1780753418 | Southeast Cancer Network, Inc | Internal Medicine | 300 Saint Lukes Dr, Montgomery, AL 36117-7102 | 2006-11-07 |
| 1780623850 | Scott A Mcdaniel | Internal Medicine | 4145 Carmichael Rd, Montgomery, AL 36106 | 2006-06-05 |
| 1902852171 | Stephen L Davidson | Internal Medicine | 4145 Carmichael Rd, Montgomery, AL 36106 | 2006-05-26 |
| 1841246022 | Keith A Thompson | Internal Medicine | 4145 Carmichael Road, Montgomery, AL 36106-2801 | 2006-05-26 |
| 1356395214 | Harry M Barnes IIi | Internal Medicine | 4145 Carmichael Road, Montgomery, AL 36106-2801 | 2006-05-22 |
| 1053303602 | William Gary Cumbie Jr. | Internal Medicine | 1722 Pine St, Ste 500, Montgomery, AL 36106-1103 | 2005-08-19 |
| Find all providers in MONTGOMERY | ||||
| City | MONTGOMERY |
| Zip Code | 36116 |
Please comment or provide details below to improve the information on SOUTHEAST CANCER NETWORK, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.