Provider Demographics
NPI:1548227093
Name:CANCER TREATMENT CENTERS OF AMERICA PROFESSIONAL CORPORATION OF WASHIN
Entity Type:Organization
Organization Name:CANCER TREATMENT CENTERS OF AMERICA PROFESSIONAL CORPORATION OF WASHIN
Other - Org Name:SEATTLE CANCER TREATMENT AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:425-223-8932
Mailing Address - Street 1:520 PIKE ST
Mailing Address - Street 2:STE #1040
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1385
Mailing Address - Country:US
Mailing Address - Phone:425-223-8932
Mailing Address - Fax:206-623-6929
Practice Address - Street 1:520 PIKE ST
Practice Address - Street 2:STE #1040
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1385
Practice Address - Country:US
Practice Address - Phone:425-223-8932
Practice Address - Fax:206-623-6929
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CTCA: PROFESSIONAL CORPORATION OF WASHINGTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-27
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601794397207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4030700001OtherMEDICARE PTAN
WAGAB02099Medicare UPIN
WA4030700001Medicare NSC