Provider Demographics
NPI:1942547146
Name:PALO VERDE HEMATOLOGY ONCOLOGY,LTD.
Entity Type:Organization
Organization Name:PALO VERDE HEMATOLOGY ONCOLOGY,LTD.
Other - Org Name:PALO VERDE CANCER SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-375-6224
Mailing Address - Street 1:5601 W EUGIE AVE
Mailing Address - Street 2:106
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1255
Mailing Address - Country:US
Mailing Address - Phone:602-978-6255
Mailing Address - Fax:602-644-3661
Practice Address - Street 1:5601 W EUGIE AVE
Practice Address - Street 2:106
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1255
Practice Address - Country:US
Practice Address - Phone:602-978-6255
Practice Address - Fax:602-644-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5338363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty