Provider Demographics
NPI:1700571643
Name:PACIFIC NORTHWEST ONCOLOGY SERVICES
Entity Type:Organization
Organization Name:PACIFIC NORTHWEST ONCOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ONCOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:971-202-1231
Mailing Address - Street 1:8710 NE BEECH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-5013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8710 NE BEECH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5013
Practice Address - Country:US
Practice Address - Phone:971-202-1231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation