Provider Demographics
NPI:1447258520
Name:HOUSTON NORTHWEST RADIOTHERAPY CENTER
Entity type:Organization
Organization Name:HOUSTON NORTHWEST RADIOTHERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA-PRUNEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-579-0061
Mailing Address - Street 1:810 PEAKWOOD DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2921
Mailing Address - Country:US
Mailing Address - Phone:281-893-3273
Mailing Address - Fax:281-893-3683
Practice Address - Street 1:810 PEAKWOOD DR
Practice Address - Street 2:SUITE D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2921
Practice Address - Country:US
Practice Address - Phone:281-893-3273
Practice Address - Fax:281-893-3683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL02416261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DT11OtherBLUE CROSS
TX160339101Medicaid
TX160339101Medicaid