Provider Demographics
NPI:1851378160
Name:RADIANTCARE PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:RADIANTCARE PHYSICIANS, PLLC
Other - Org Name:RADIANTCARE RADIATION ONCOLOGY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BAISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-412-8969
Mailing Address - Street 1:4525 3RD AVE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1010
Mailing Address - Country:US
Mailing Address - Phone:360-412-8960
Mailing Address - Fax:360-412-8970
Practice Address - Street 1:4525 3RD AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1010
Practice Address - Country:US
Practice Address - Phone:360-412-8960
Practice Address - Fax:360-412-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7099153Medicaid
WA7099153Medicaid