1770736324 NPI number — RADIATION ONCOLOGISTS OF CENTRAL ARIZONA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770736324 NPI number — RADIATION ONCOLOGISTS OF CENTRAL ARIZONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIATION ONCOLOGISTS OF CENTRAL ARIZONA
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:
1770736324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4611 E. SHEA BLVD
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85028-4254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-441-3845
Provider Business Mailing Address Fax Number:
602-464-9769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4611 E. SHEA BLVD
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85028-4245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-441-3845
Provider Business Practice Location Address Fax Number:
602-464-9769
Provider Enumeration Date:
10/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KRESL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGEMENT/COMMITTEE MEMBER
Authorized Official Telephone Number:
602-441-3845

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: 391486 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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