Provider Demographics
NPI:1013991652
Name:THE TRI-CITIES CANCER CENTER
Entity type:Organization
Organization Name:THE TRI-CITIES CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:DEGOOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-783-9894
Mailing Address - Street 1:7350 W DESCHUTES AVE
Mailing Address - Street 2:BLDG A
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7802
Mailing Address - Country:US
Mailing Address - Phone:509-783-9894
Mailing Address - Fax:509-783-3194
Practice Address - Street 1:7350 W DESCHUTES AVE
Practice Address - Street 2:BLDG A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7802
Practice Address - Country:US
Practice Address - Phone:509-783-9894
Practice Address - Fax:509-783-3194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7060171Medicaid
WA470000264OtherRAILROAD ID #
WA7060171Medicaid