BLOOD AND CANCER CLINIC, PA


Address: 2125 Valleygate Dr, Suite 101, Fayetteville, NC 28304-3657
Phone: 9104838586

BLOOD AND CANCER CLINIC, PA (NPI# 1174747711) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1174747711
Entity Type Organization
Organization Name BLOOD AND CANCER CLINIC, PA
Practice Address 2125 Valleygate Dr
Suite 101
Fayetteville
NC 28304-3657
Mailing Address Po Box 53095
Fayetteville
NC 28305-3095
Practice Telephone 9104838586
Practice Fax Number 9104839212
Mailing Telephone 9104838586
Mailing Fax Number 9104839212
Enumeration Date 2007-04-13
Last Update Date 2020-08-22
Authorized Official Name DR. SHIRISH D DEVASTHALI (PRESIDENT)
Authorized Official Telephone 9104838586
Authorized Official Credential MD
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 332900000X Non-Pharmacy Dispensing Site Suppliers

Other Provider Identifier

State Issuer Identifier Type Code
NC BOARD OF PHARMACY 02699 01
NC NCPDP NUMBER 3400936 01
NC LICENSE NUMBER 38929 01
NC BOARD OF PHARMACY 02701 01

Office Location

Street Address 2125 VALLEYGATE DR
SUITE 101
City FAYETTEVILLE
State NC
Zip Code 28304-3657

Providers in the same location

NPI Name Taxonomy Address Enumeration
1467455899 All American Rehabilitation Solutions Physical Therapist 2125 Valleygate Dr, Suite 101, Fayetteville, NC 28304-3753 2005-05-31
1528419744 American Arthritis & Rheumatology Associates-nc Pllc Internal Medicine 2125 Valleygate Dr, Suite 201, Fayetteville, NC 28304-3753 2016-06-29
1538558663 Katherine Cole Physician Assistant 2125 Valleygate Dr, Suite 201, Fayetteville, NC 28304-3753 2015-01-13
1013227495 Shelley Barry Follett Nurse Practitioner 2125 Valleygate Dr, Suite 201, Fayetteville, NC 28304-3753 2010-10-19
1437275161 Pamela Hudak Physician Assistant 2125 Valleygate Dr, Suite 201, Fayetteville, NC 28304-3753 2007-03-22
1134269251 Seema S Devasthali Physical Therapist 2125 Valleygate Dr, Suite 101-a, Fayetteville, NC 28304-3657 2007-02-07
1649354317 Casey Cathleen Benander Physical Therapist 2125 Valleygate Dr, Suite 101, Fayetteville, NC 28304-3753 2006-10-25
1356455059 Lafayette Clinic, Pa Internal Medicine 2125 Valleygate Dr, Suite 201, Fayetteville, NC 28304-3753 2006-08-18
1780697326 Gwenesta Barnum Melton Internal Medicine 2125 Valleygate Dr, Suite 201, Fayetteville, NC 28304-3753 2006-08-14

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1538717764 Rose Mary A O'conner Technician 3530 Madison Ave, Fayetteville, NC 28304 2019-08-30
1932756087 Sally Frances Jones Technician 2053 Mango Circle, Fayetteville, NC 28304 2019-08-23
1326528803 Jeneen Yvette Townsend Counselor 2671 Adams Lake Dr Apt F, Fayetteville, NC 28304 2018-08-15
1780179580 Ma Cornelia Villavicencio Leano Nurse Practitioner 3081 Stone Carriage Cir Apt Z, Fayetteville, NC 28304 2018-06-25
1861986267 Pediatric After Hours Care of Fayetteville Pediatrics 556 Sandhurst Drive, Fayetteville, NC 28304 2018-06-19
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Taxonomy Information

Taxonomy Code 332900000X
Grouping Suppliers
Classification Non-Pharmacy Dispensing Site

Taxonomy Definition

A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
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1336554153 Urgent Cares of America Nc Inc Non-Pharmacy Dispensing Site 4401 Ramsey St, Suite 104, Fayetteville, NC 28311-2202 2014-07-01
1174955249 Planned Parenthood of Central North Carolina, Inc. Non-Pharmacy Dispensing Site 4551 Yadkin Rd, Fayetteville, NC 28303-3421 2013-07-31
1205174141 Urgent Cares of America North Carolina Inc Non-Pharmacy Dispensing Site 3007 Town Center Dr, 100-101, Fayetteville, NC 28306-3639 2013-01-28
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1902212541 Breezewood Healthcare P A Non-Pharmacy Dispensing Site 200 Forsythe St, Fayetteville, NC 28303-5426 2014-07-03
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1700137791 Merrell Foot Clinic, PC Non-Pharmacy Dispensing Site 2250 Thornton Taylor Pkwy, Suite B, Fayetteville, TN 37334-3651 2012-10-01
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Competitor

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City FAYETTEVILLE
Zip Code 28304

Improve Information

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Dataset Information

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.

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