SOUTHEAST CANCER NETWORK, INC (NPI# 1578633566) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578633566 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST CANCER NETWORK, INC |
| Other Organization Name | CANCER CARE CENTER AT MMCS |
| Practice Address |
2505 Us Hwy 431 Boaz AL 35957 |
| Mailing Address |
1400 Afflink Pl Ste 100 Tuscaloosa AL 35406-2289 |
| Practice Telephone | 2568403688 |
| Mailing Telephone | 2053669740 |
| Mailing Fax Number | 2053449992 |
| Enumeration Date | 2006-11-08 |
| 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 AT MMCS | 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 |
| 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 |
| 1255400834 | Southeast Cancer Network, Inc | Internal Medicine | 2055 E South Blvd, Ste 202, Montgomery, AL 36116-2001 | 2006-11-07 |
| Street Address |
2505 US HWY 431 |
| City | BOAZ |
| State | AL |
| Zip Code | 35957 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790104677 | Jonathan Hannah | Nurse Practitioner | 2505 Us Hwy 431, Boaz, AL 35957 | 2014-04-08 |
| 1659568012 | Jonathan Ashe Storey | Internal Medicine | 2505 Us Hwy 431, Boaz, AL 35957 | 2007-10-01 |
| 1669510210 | Ginger Roden Taylor | Nurse Anesthetist, Certified Registered | 2505 Us Hwy 431, Boaz, AL 35957 | 2007-02-02 |
| 1326116880 | Marshall Medical Center South | Family Medicine | 2505 Us Hwy 431, Boaz, AL 35957 | 2006-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124639935 | Twindom Counseling Services, LLC | Community/Behavioral Health | 202 Lackey Street, Boaz, AL 35957 | 2020-08-14 |
| 1407464308 | Brittany C Mcclendon | Nurse Practitioner | 2505 Us Hwy. 431, Suite A, Women's Center, Boaz, AL 35957 | 2020-07-16 |
| 1942831169 | Kayleigh Danielle Eller | Student in an Organized Health Care Education/Training Program | 147 Stephans Road, Boaz, AL 35957 | 2020-01-27 |
| 1710443767 | Antallia Shauntell Johnson | Nurse Practitioner | 2505 Us Hwy 431 Women's Center Suite A, Boaz, AL 35957 | 2019-02-14 |
| 1649516659 | Tiffany Brown Butler | Nurse Practitioner | 2505 U.S. Highway 431, Boaz, AL 35957 | 2012-12-19 |
| 1811263270 | Abundant Life Family Chiropractic LLC | Chiropractor | 100 Bel Air St, Boaz, AL 35957 | 2012-03-29 |
| 1659696375 | Rachel Lambert | Pharmacist | 10402 Al Hwy 168, Boaz, AL 35957 | 2010-04-06 |
| 1407028368 | Brenda J Parrish | Nurse Practitioner | 2505highway 431, Boaz, AL 35957 | 2008-03-31 |
| 1942346234 | Candi Denise Blackwell | Nurse Anesthetist, Certified Registered | 2055 Us Hwy 431, Boaz, AL 35957 | 2007-01-30 |
| 1558418426 | Gideon P Ewing | Internal Medicine | 2505 Highway 431, Boaz, AL 35957 | 2007-01-04 |
| Find all providers in zip 35957 | ||||
| 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 |
|---|---|---|---|---|
| 1336409838 | Marshall Medical Center South Medical Oncology Services | Internal Medicine | 2505 U. S. Highway 431, Boaz, AL 35957-9999 | 2012-05-18 |
| 1558418426 | Gideon P Ewing | Internal Medicine | 2505 Highway 431, Boaz, AL 35957 | 2007-01-04 |
| 1659568012 | Jonathan Ashe Storey | Internal Medicine | 2505 Us Hwy 431, Boaz, AL 35957 | 2007-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801211958 | Antonio Di Stasi | Internal Medicine | 1802 6th Ave S # Np255, Birmingham, AL 35233-1932 | 2014-02-26 |
| 1417398033 | Rehan Ajmal Sarmad | Internal Medicine | 625 19th Street South Birmingham, Birmingham, AL 35249 | 2013-07-11 |
| 1548550833 | John Richard Nicholson IIi | Internal Medicine | 201 Sivley Rd Sw Ste 200, Huntsville, AL 35801-5177 | 2011-04-08 |
| 1093018681 | Shelby-chilton Hematology and Oncology LLC | Internal Medicine | 644 2nd St Ne Ste 202, Alabaster, AL 35007-8823 | 2010-12-21 |
| 1003122573 | Amitkumar Mehta | Internal Medicine | 1720 2nd Ave S # Np2540t, Birmingham, AL 35294-3528 | 2010-08-23 |
| 1447579644 | Alabama Cancer Care, LLC | Internal Medicine | 171 Town Center Dr Ste 6, Anniston, AL 36205 | 2010-05-27 |
| 1033443775 | Hematology & Oncology Associates of Alabama | Internal Medicine | 339 Walker Chapel Plaza, Suite 109, Fultondale, AL 35068 | 2009-09-29 |
| 1831350198 | David James Mooney | Internal Medicine | 513 Brookwood Blvd Ste 275, Birmingham, AL 35209-6806 | 2008-06-19 |
| 1578755815 | Oncology Specialties, PC | Internal Medicine | 310 8th Ave Se, Decatur, AL 35601 | 2007-08-10 |
| 1598965972 | Gabrielle B Rocque | Internal Medicine | Uab Comprehensive Cancer Ctr, 1824 6th Avenue South - Wti 240g, Birmingham, AL 35294-3300 | 2007-07-23 |
| Find all providers with the same taxonomy | ||||
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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.