Provider Demographics
NPI:1023494291
Name:ARIZONA ONCOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:ARIZONA ONCOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-487-3723
Mailing Address - Street 1:1760 E RIVER RD
Mailing Address - Street 2:STE. # 350
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5877
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7910
Practice Address - Street 1:1521 E TANGERINE RD
Practice Address - Street 2:STE. # 157
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-6225
Practice Address - Country:US
Practice Address - Phone:520-229-2095
Practice Address - Fax:520-229-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332900000X
AZ3191363A00000X
AZ19672207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ289515Medicaid
AZ289515Medicaid