Provider Demographics
NPI:1457576357
Name:NORTHWEST WASHINGTON RADIATION ONCOLOGY
Entity Type:Organization
Organization Name:NORTHWEST WASHINGTON RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-788-8231
Mailing Address - Street 1:3301 SQUALICUM PKWY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1919
Mailing Address - Country:US
Mailing Address - Phone:360-788-8222
Mailing Address - Fax:360-756-4801
Practice Address - Street 1:3301 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1919
Practice Address - Country:US
Practice Address - Phone:360-788-8222
Practice Address - Fax:360-756-4801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST WASHINGTON RADIATION ONCOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-16
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7064314Medicaid
WA7064314Medicaid