Provider Demographics
NPI:1053451617
Name:GAMMAWEST BRACHYTHERAPY, LLC
Entity Type:Organization
Organization Name:GAMMAWEST BRACHYTHERAPY, LLC
Other - Org Name:GAMMA WEST CANCER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP HR & COO
Authorized Official - Prefix:
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RHYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:156-467-7415
Mailing Address - Street 1:104 WOODMONT BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:615-783-1254
Mailing Address - Fax:615-783-1082
Practice Address - Street 1:1250 E 3900 S # B-10
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1348
Practice Address - Country:US
Practice Address - Phone:801-456-8401
Practice Address - Fax:801-456-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2054905-01602085R0001X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055914Medicare PIN
UT005593503Medicare PIN
UT000076877Medicare PIN
UT000055941Medicare PIN
UT000064427Medicare PIN
UT000066999Medicare PIN
UT005805002Medicare PIN
UT005591402Medicare PIN
UT005591405Medicare PIN