Provider Demographics
NPI:1982662714
Name:NORTHWEST WASHINGTON RADIATION ONCOLOGY
Entity Type:Organization
Organization Name:NORTHWEST WASHINGTON RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:WISBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-297-5597
Mailing Address - Street 1:PO BOX 84642
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5942
Mailing Address - Country:US
Mailing Address - Phone:425-297-5597
Mailing Address - Fax:425-297-5598
Practice Address - Street 1:1717 13TH ST STE 200
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1621
Practice Address - Country:US
Practice Address - Phone:425-297-5597
Practice Address - Fax:425-297-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8308744Medicaid
WAG001248800Medicare PIN
WAG001248803Medicare PIN
WAE40299Medicare UPIN