Provider Demographics
NPI:1457351991
Name:COMMUNITY CANCER FOUNDATION
Entity Type:Organization
Organization Name:COMMUNITY CANCER FOUNDATION
Other - Org Name:COMMUNITY CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEDORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-673-2267
Mailing Address - Street 1:2880 NW STEWART PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1201
Mailing Address - Country:US
Mailing Address - Phone:541-673-2267
Mailing Address - Fax:541-672-9483
Practice Address - Street 1:2880 NW STEWART PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1201
Practice Address - Country:US
Practice Address - Phone:541-673-2267
Practice Address - Fax:541-672-9483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, RadiationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000773Medicaid
OR002524000OtherREGENCE BCBS OF OREGON
OR4308388OtherREGENCE BCBS PC65
OR000773Medicaid
ORR103396Medicare ID - Type Unspecified