Provider Demographics
NPI:1629184155
Name:MOORHEAD RADIATION ONCOLOGY
Entity Type:Organization
Organization Name:MOORHEAD RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MOORHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-574-3663
Mailing Address - Street 1:PO BOX 661057
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1057
Mailing Address - Country:US
Mailing Address - Phone:626-445-0234
Mailing Address - Fax:626-445-0302
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3462
Practice Address - Country:US
Practice Address - Phone:626-574-3657
Practice Address - Fax:626-445-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA236702085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZ09450ZOtherBLUE SHIELD
CA00A236700Medicaid
CAA23670OtherBLUE CROSS
CAZZ09450ZOtherBLUE SHIELD
CAW16933Medicare ID - Type Unspecified