Provider Demographics
NPI:1720009640
Name:TORRANCE RADIATION ONCOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:TORRANCE RADIATION ONCOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-374-5417
Mailing Address - Street 1:PO BOX 14556
Mailing Address - Street 2:BUSINESS OFFICE
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-8556
Mailing Address - Country:US
Mailing Address - Phone:310-517-4785
Mailing Address - Fax:310-784-4820
Practice Address - Street 1:510 N PROSPECT AVE
Practice Address - Street 2:#104
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3028
Practice Address - Country:US
Practice Address - Phone:310-374-5417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0047010Medicaid
CAGR0047010Medicaid