Provider Demographics
NPI:1346215571
Name:ADVANCED RADIATION ONCOLOGY SERVICES, MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ADVANCED RADIATION ONCOLOGY SERVICES, MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-450-5530
Mailing Address - Street 1:7130 N MILLBROOK AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3347
Mailing Address - Country:US
Mailing Address - Phone:559-450-5530
Mailing Address - Fax:559-450-3064
Practice Address - Street 1:7130 N MILLBROOK AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3347
Practice Address - Country:US
Practice Address - Phone:559-450-5530
Practice Address - Fax:559-450-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01561ZOtherPTAN
CAGR0069701Medicaid
CAZZZ43538ZOtherMEDICARE-PTAN
CAZZZ43539ZOtherPTAN
CAGR0069700Medicaid
CAGR0069702Medicaid