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Contact Information

FAMILY CANCER CENTER, PLLC
391 SOUTHCREST CIR
SUITE 101
SOUTHAVEN, MS38671-4848
 Phone: 662-349-0755
 Fax: 662-349-0356
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Specialist

174400000X
 

Hematology & Oncology

207RH0003X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for FAMILY CANCER CENTER, PLLC

NPI Number 1407862899
LBN Legal business name FAMILY CANCER CENTER, PLLC
Authorized official WILLIAM WALSH - (MANAGING PHYSICIAN)
Entity Organization
Organization subpart 1 No
Enumeration date 07/31/2006
Last updated 03/09/2011 - About 15 years ago
Identifiers
MS License # 18137
TN License # 19652
MS Medicaid 0090015910
MS Medicaid 090015910
MS Other CK3826 RRMCR
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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