# KERRVILLE CANCER CENTER LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083622781
- **Authorized official:** SANDY RIOS CCS-P (ADMINISTRATIVE ASSISTANT)
- **Authorized official phone:** (830) 257-2191

## Contact information

- **Practice address:** 218 SIDNEY BAKER ST, KERRVILLE, TX 78028-5367
- **Practice address phone:** (830) 257-2070
- **Practice address fax:** (830) 257-2079
- **Mailing address:** 218 SIDNEY BAKER ST, KERRVILLE, TX 78028-5367
- **Mailing address phone:** (830) 257-2070
- **Mailing address fax:** (830) 257-2079

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0203X | Radiation Oncology Clinic/Center | R17560 | TX | Yes |

## Other

- **Enumeration date:** 08/04/2006
- **Last updated:** 03/11/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0143426801 | — | TX |
| 01 | — | 0153DC | BC/BS | TX |