1548227093 NPI number — CANCER TREATMENT CENTERS OF AMERICA PROFESSIONAL CORPORATION OF WASHIN

Table of content: (NPI 1548227093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548227093 NPI number — CANCER TREATMENT CENTERS OF AMERICA PROFESSIONAL CORPORATION OF WASHIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANCER TREATMENT CENTERS OF AMERICA PROFESSIONAL CORPORATION OF WASHIN
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:
6
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:
1548227093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 PIKE ST
Provider Second Line Business Mailing Address:
STE #1040
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98101-1385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-223-8932
Provider Business Mailing Address Fax Number:
206-623-6929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 PIKE ST
Provider Second Line Business Practice Location Address:
STE #1040
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101-1385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-223-8932
Provider Business Practice Location Address Fax Number:
206-623-6929
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOYCE
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
425-223-8932

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  601794397 , 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: 4030700001 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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