Blood & Cancer Clinic, P.a.

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

38929 Issued in NC

Legal business name

BLOOD & CANCER CLINIC, P.A.

Practice address

1565 Purdue Dr
Suite 301
Fayetteville, NC 28303-5536

Phone

(910) 483-8586

Fax

(910) 483-9212

NPI assigned

Jan 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shirish D Devasthali, M.D.

Title

President

Phone

(910) 483-8586

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371686400000",
    "number": "1437209632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 53095",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283053095",
            "telephone_number": "910-483-8586",
            "fax_number": "910-483-9212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1565 PURDUE DR",
            "address_2": "SUITE 301",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035536",
            "telephone_number": "910-483-8586",
            "fax_number": "910-483-9212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOD & CANCER CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2013-06-20",
        "status": "A",
        "authorized_official_last_name": "DEVASTHALI",
        "authorized_official_first_name": "SHIRISH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-483-8586",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NC",
            "license": "38929",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NC",
            "license": "200401286",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "011G3",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89011G3",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blessed Open Arms
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• Evette Lemille Blevins
• Monica Block, OTR/L
• Kyle Paul Blomgren, DO
• Blood and Cancer Clinic, PA
• Bloom in Journey PLLC
• Crystal Lynn Bloomer, LPN
• Bridget Blount
• Andrea Blue, RBT

• Hematology & Oncology Physician in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Hematology & Oncology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.