| Gulf Coast Cancer & Diagnostic Center At Southeast | |
|
12811 Beamer Rd Houston TX 77089-6140 | |
| (713) 474-1414 | |
| (713) 474-8477 |
| Full Name | Gulf Coast Cancer & Diagnostic Center At Southeast |
|---|---|
| Speciality | Clinic/Center |
| Location | 12811 Beamer Rd, Houston, Texas |
| Authorized Official Name and Position | Mark A Dandrea (OWNER) |
| Authorized Official Contact | 7134741414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Coast Cancer & Diagnostic Center At Southeast Po Box 7894 Pasadena TX 77508-7894 Ph: (713) 474-1414 | Gulf Coast Cancer & Diagnostic Center At Southeast 12811 Beamer Rd Houston TX 77089-6140 Ph: (713) 474-1414 |
| NPI Number | 1194723296 |
|---|---|
| Provider Enumeration Date | 07/12/2005 |
| Last Update Date | 04/19/2016 |
| Medicare PECOS PAC ID | 8426032897 |
|---|---|
| Medicare Enrollment ID | O20040614001570 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194723296 | NPI | - | NPPES |
| 149577201 | Medicaid | TX | |
| 0212DC | Other | TX | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QX0203X | Clinic/center - Oncology, Radiation | (* (Not Available)) | Primary |
| Provider Name | Mark A Dandrea |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1326081993 PECOS PAC ID: 8325022791 Enrollment ID: I20050609000727 |
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