Provider Demographics
NPI:1750582888
Name:CONCORDIA ONCOLOGY, PC
Entity type:Organization
Organization Name:CONCORDIA ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLIS
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-614-0556
Mailing Address - Street 1:10250 N 92ND ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4510
Mailing Address - Country:US
Mailing Address - Phone:480-614-0556
Mailing Address - Fax:480-614-9810
Practice Address - Street 1:6242 E ARBOR AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1309
Practice Address - Country:US
Practice Address - Phone:480-668-7060
Practice Address - Fax:480-668-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ170879Medicaid
AZMD15515Medicare ID - Type Unspecified
AZ170879Medicaid