Provider Demographics
NPI:1033435730
Name:VISTA ONCOLOGY INC PS
Entity Type:Organization
Organization Name:VISTA ONCOLOGY INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:360-413-8880
Mailing Address - Street 1:141 LILLY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5028
Mailing Address - Country:US
Mailing Address - Phone:360-413-8880
Mailing Address - Fax:360-350-4838
Practice Address - Street 1:141 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5028
Practice Address - Country:US
Practice Address - Phone:360-413-8880
Practice Address - Fax:360-350-4838
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISTA ONCOLOGY INC PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043241174400000X
WAMD00043519174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7142987Medicaid
WA8392730Medicaid
WA8391430Medicaid
WAH96096Medicare UPIN