Provider Demographics
NPI:1255819736
Name:PHOENIX CANCER AND BLOOD DISORDER TREATMENT INSTITUTE PLLC
Entity type:Organization
Organization Name:PHOENIX CANCER AND BLOOD DISORDER TREATMENT INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-817-1544
Mailing Address - Street 1:967 HANCOCK RD 133
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442
Mailing Address - Country:US
Mailing Address - Phone:928-224-0064
Mailing Address - Fax:480-842-8608
Practice Address - Street 1:967 HANCOCK RD 133
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-224-0064
Practice Address - Fax:480-842-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ406031Medicaid