Provider Demographics
NPI:1952314635
Name:PACIFIC ONCOLOGY PC
Entity Type:Organization
Organization Name:PACIFIC ONCOLOGY PC
Other - Org Name:WILLIAM MOONEY MD
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:503-203-1000
Mailing Address - Street 1:15700 SW GREYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6011
Mailing Address - Country:US
Mailing Address - Phone:503-203-1000
Mailing Address - Fax:
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:STE 362
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2991
Practice Address - Country:US
Practice Address - Phone:503-232-7000
Practice Address - Fax:503-232-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26633332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR054853Medicaid
3842398OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OR054853Medicaid
OR0978250001Medicare NSC