Provider Demographics
NPI:1740353788
Name:RADIATION ONCOLOGY PROFESSIONAL SERVICES, P.C.
Entity type:Organization
Organization Name:RADIATION ONCOLOGY PROFESSIONAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARB
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLETT BRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-728-8420
Mailing Address - Street 1:PO BOX 17528
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-7528
Mailing Address - Country:US
Mailing Address - Phone:406-728-8420
Mailing Address - Fax:406-541-8430
Practice Address - Street 1:2825 STOCKYARD RD STE I-200
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1548
Practice Address - Country:US
Practice Address - Phone:406-728-8420
Practice Address - Fax:406-541-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty