Provider Demographics
NPI:1558638163
Name:NORTHWEST CANCER CLINIC, LLC
Entity Type:Organization
Organization Name:NORTHWEST CANCER CLINIC, LLC
Other - Org Name:NORTHWEST CANCER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:REGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-987-1800
Mailing Address - Street 1:7379 W DESCHUTES AVE
Mailing Address - Street 2:STE 100
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:
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:2011-11-28
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603 042 4912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty