Provider Demographics
NPI:1164810545
Name:NORTHWEST CANCER CARE ASSOCIATES PC
Entity Type:Organization
Organization Name:NORTHWEST CANCER CARE ASSOCIATES PC
Other - Org Name:NORTHWEST CANCER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-932-8288
Mailing Address - Street 1:7379 W DESCHUTES AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7900
Mailing Address - Country:US
Mailing Address - Phone:509-987-1800
Mailing Address - Fax:509-987-1808
Practice Address - Street 1:7379 W DESCHUTES AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7900
Practice Address - Country:US
Practice Address - Phone:509-987-1800
Practice Address - Fax:509-987-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1164810545Medicaid