Provider Demographics
NPI:1013954858
Name:COCHISE ONCOLOGY LLC
Entity Type:Organization
Organization Name:COCHISE ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NETTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-559-3684
Mailing Address - Street 1:PO BOX 1418
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85636-1418
Mailing Address - Country:US
Mailing Address - Phone:520-803-6644
Mailing Address - Fax:520-459-3193
Practice Address - Street 1:5151 E HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2436
Practice Address - Country:US
Practice Address - Phone:520-803-6644
Practice Address - Fax:520-459-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ109908Medicare PIN