1184736340 NPI number — ONCOLOGY GROUP PLLC

Table of content: (NPI 1184736340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184736340 NPI number — ONCOLOGY GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONCOLOGY GROUP PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184736340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
512 N YOUNG ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336-7806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-374-3915
Provider Business Mailing Address Fax Number:
509-374-8036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7350 W DESCHUTES
Provider Second Line Business Practice Location Address:
BUILDING A
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-737-3371
Provider Business Practice Location Address Fax Number:
509-736-0958
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REGE
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
509-374-3915

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7096357 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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