Provider Demographics
NPI:1053649475
Name:CLACKAMAS RADIATION ONCOLOGY CENTER
Entity Type:Organization
Organization Name:CLACKAMAS RADIATION ONCOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG-CHESEBRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-513-3300
Mailing Address - Street 1:PO BOX 3867
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3867
Mailing Address - Country:US
Mailing Address - Phone:503-215-8584
Mailing Address - Fax:503-215-6387
Practice Address - Street 1:9280 SE SUNNYBROOK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6899
Practice Address - Country:US
Practice Address - Phone:503-215-1837
Practice Address - Fax:503-215-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QX0203X
OR261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
R152248Medicare UPIN