Provider Demographics
NPI:1013299817
Name:YUMA REGIONAL CANCER CENTER, LLC
Entity Type:Organization
Organization Name:YUMA REGIONAL CANCER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-317-2518
Mailing Address - Street 1:2400 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7127
Mailing Address - Country:US
Mailing Address - Phone:928-317-2518
Mailing Address - Fax:928-317-1811
Practice Address - Street 1:2375 S RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8868
Practice Address - Country:US
Practice Address - Phone:928-317-2518
Practice Address - Fax:928-317-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ150374Medicare PIN