Organization
CLEBURNE CANCER CENTER LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDY RIOS CCS-P (ADMINISTRATIVE ASSISTANT)
(830) 257-2191
Entity
Organization
Contact information
Practice address
191 WALLS DR, CLEBURNE, TX 76033-4033
(817) 648-0120
(817) 648-0121
Mailing address
218 SIDNEY BAKER ST, KERRVILLE, TX 78028-5367
(830) 257-2070
(830) 257-2079
Taxonomy
Speciality
Code
Description
License number
State
261QX0203X
Radiation Oncology Clinic/Center
Primary
R26579
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0216DC
BC/BS
TX
Enumeration date
08/04/2006
Last updated
08/22/2020
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