1184632572 NPI number — TUMOR INSTITUTE RADIATION ONCOLOGY GROUP LLP

Table of content: (NPI 1184632572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184632572 NPI number — TUMOR INSTITUTE RADIATION ONCOLOGY GROUP LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TUMOR INSTITUTE RADIATION ONCOLOGY GROUP LLP
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:
1184632572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 749730
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-9730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-709-4485
Provider Business Mailing Address Fax Number:
302-733-0854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 MADISON ST
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-3589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-386-2323
Provider Business Practice Location Address Fax Number:
206-385-6150
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONAHAN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
206-320-7129

Provider Taxonomy Codes

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

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

  • Identifier: CS0846 . This is a "RAILROAD MEDICARE-PALMETTO GBA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7805203 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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