Organization
MAYHILL CANCER CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVELLE R HARDIN (CREDENTIALING COORDINATOR)
(615) 373-7600
Entity
Organization
Contact information
Practice address
3537 SOUTH I - 35, SUITE 111, DENTON, TX 76210
(940) 382-7830
(904) 688-7227
Mailing address
3537 SOUTH I - 35, SUITE 111, DENTON, TX 76210
(940) 382-7830
(904) 688-7227
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0688D
BCBS OF TX
TX
05
—
195372101
—
TX
Enumeration date
06/26/2007
Last updated
11/11/2008
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