COMMUNITY CANCER CARE SPECIALISTS (NPI# 1407962442) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407962442 |
| Entity Type | Organization |
| Organization Name | COMMUNITY CANCER CARE SPECIALISTS |
| Other Organization Name | PAUL M DERDERIAN DO |
| Practice Address |
1030 Harrington St Ste 301 Mount Clemens MI 48043-2967 |
| Practice Telephone | 5864933440 |
| Practice Fax Number | 5864933455 |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | LESLIE NOWAK (PRACTICE MANAGER) |
| Authorized Official Telephone | 5864933435 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 332900000X | Non-Pharmacy Dispensing Site | Suppliers | ||
| X | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
5101009575 | MI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER-COMMERCIAL NUMBER | 2368430 | 01 |
| Other Name | Type Code |
|---|---|
| PAUL M DERDERIAN DO | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760411680 | Community Cancer Care Specialists | Internal Medicine | 1080 Harrington St, Suite 202, Mount Clemens, MI 48043-2901 | 2006-07-02 |
| Street Address |
1030 HARRINGTON ST STE 301 |
| City | MOUNT CLEMENS |
| State | MI |
| Zip Code | 48043-2967 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295725620 | Stephen Douglas Cahill | Surgery | 1030 Harrington St, Suite 103, Mount Clemens, MI 48043-2967 | 2005-10-26 |
| 1053703074 | Carmen Epstein | Dietitian, Registered | 1030 Harrington St, Suite 202, Mount Clemens, MI 48043-2967 | 2015-02-27 |
| 1447692819 | Kim N Poludnianyk Do PC | Orthopaedic Surgery | 1030 Harrington St, Suite 303, Mount Clemens, MI 48043-2967 | 2013-07-25 |
| 1144531500 | Ashley N Harnden | Surgery | 1030 Harrington St, Suite 103, Mount Clemens, MI 48043-2967 | 2010-06-30 |
| 1457591174 | Select Surgical Pllc | Surgery | 1030 Harrington St, 103, Mount Clemens, MI 48043-2967 | 2009-02-21 |
| 1750544268 | Sibin K Zacharias | Internal Medicine | 1030 Harrington St, Ste 101, Mount Clemens, MI 48043-2967 | 2008-07-03 |
| 1174704985 | Carol M Fischer Do Pllc | Clinic/Center | 1030 Harrington St, Suite 201, Mount Clemens, MI 48043-2967 | 2007-11-20 |
| 1093915910 | Michigan Vascular Institute Pllc | Surgery | 1030 Harrington St, Suite 103, Mount Clemens, MI 48043-2967 | 2007-07-19 |
| 1689879629 | Michigan Neurology, P.l.l.c. | Specialist | 1030 Harrington St, Suite 205, Mount Clemens, MI 48043-2967 | 2007-06-19 |
| 1962550053 | Michigan Oncology Hematology Pllc | Specialist | 1030 Harrington St, Suite 103, Mount Clemens, MI 48043-2967 | 2007-01-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699300228 | Blue Diamond Aba Services LLC | Assistant Behavior Analyst | 102 North Avenue, Mt. Clemens, MI 48043 | 2020-03-04 |
| 1265086136 | Venture Counseling | Social Worker | 198 S. Main Street, Suite 2, Mount Clemens, MI 48043 | 2019-07-30 |
| 1386203651 | Michele Lee Casebolt | Physical Therapist | 30795 Twenty Three Mile Rd., Chesterfield, MI 48043 | 2019-06-11 |
| 1730669706 | Wynn A Mitchell | Case Manager/Care Coordinator | 24 Hubbard St, Mount Clemens, MI 48043 | 2018-08-18 |
| 1629520101 | Boitshoko Marang | Family Medicine | Clinton River Drive 11a, Mount Clemens, MI 48043 | 2016-10-31 |
| 1720332265 | New Passages | Point of Service | 175 N. Grorsebeck Hwy, Mt. Clemens, MI 48043 | 2012-11-06 |
| 1376807784 | Christopher John Shamass | Emergency Medicine | 1000 Harrington Boulevard, Mount Clemens, MI 48043 | 2012-06-29 |
| 1265749683 | Mycare Health Center | Clinic/Center | 18 Market Street, Suite C, Mount Clemens, MI 48043 | 2010-09-07 |
| 1114102837 | George Edward Perron | Family Medicine | 256 Wellington Crescent, Mt Clemens, MI 48043 | 2007-12-31 |
| 1558568733 | Dawood Ghassan Dalaly | Surgery | 1000 Harrington, Mt Clemens, MI 48043 | 2007-06-29 |
| Find all providers in zip 48043 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720559792 | Michigan Surgery Specialists, P.C. | Non-Pharmacy Dispensing Site | 11012 E 13 Mile Rd Ste 201, Warren, MI 48093-2547 | 2018-12-17 |
| 1811468184 | Michigan Surgery Specialists, P.C. | Non-Pharmacy Dispensing Site | 18245 E 10 Mile Rd Ste 130, Roseville, MI 48066-5807 | 2018-12-16 |
| 1407327778 | Michigan Surgery Specialists, P.C. | Non-Pharmacy Dispensing Site | 3100 Cross Creek Pkwy Ste 150, Auburn Hills, MI 48326-2777 | 2018-12-16 |
| 1003332271 | Wrs Pharmacy Solutions, LLC | Non-Pharmacy Dispensing Site | 112 S Main St Ste A, Ann Arbor, MI 48104-1953 | 2017-08-18 |
| 1457759144 | Perfect Eyes Optical LLC | Non-Pharmacy Dispensing Site | 20880 Gratiot Ave, Eastpointe, MI 48021-2822 | 2014-12-11 |
| 1346478740 | Pristine Medical LLC | Non-Pharmacy Dispensing Site | 1502 W West Maple Rd, Walled Lake, MI 48390-2945 | 2009-06-24 |
| 1801910807 | Wolverine Optical Inc | Non-Pharmacy Dispensing Site | 7314 N Alger Rd, Alma, MI 48801-1072 | 2007-03-17 |
| 1255439253 | Anthony J Derrico Do | Non-Pharmacy Dispensing Site | Cancer Care Associates PC, 1701 S Blvd East Ste 350, Rochester Hills, MI 48307 | 2006-09-21 |
| 1336246263 | Clinical Oncology Associates | Non-Pharmacy Dispensing Site | 30160 Orchard Lake Rd, Ste 100, Farmington Hills, MI 48334-2293 | 2006-09-20 |
| 1730124934 | Northpointe Pediatrics PC | Non-Pharmacy Dispensing Site | 30061 Schoenherr Rd, Ste A, Warren, MI 48088-3133 | 2006-06-19 |
| Find all providers with the same taxonomy | ||||
| City | MOUNT CLEMENS |
| Zip Code | 48043 |
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| 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.