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NPI Code Detail

MEDICARE: MEDICAL ONCOLOGY ASSOCIATES PS

MEDICARE: MEDICAL ONCOLOGY ASSOCIATES PS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RH0003XHematology & Oncology PhysicianMD00046241WA
2207RH0003XHematology & Oncology PhysicianMD00037930WA

General Provider Information

NPI Number : 1518285824
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICAL ONCOLOGY ASSOCIATES PS
Provider Business Mailing Address
First Line : PO BOX 996
Second Line :
City : HAYDEN
State : ID
Zip : 83835-0996
Country : US
Telephone Number : 208-664-4026
Fax Number : 208-664-4840
Provider Business Practice Location Address
First Line : 6001 N MAYFAIR ST
Second Line :
City : SPOKANE
State : WA
Zip : 99208-1129
Country : US
Telephone Number : 509-462-2273
Fax Number : 509-462-2275
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : LINDA A DURKIN
Credential :
Telephone Number : 208-664-4026
Provider Enumeration Date : 05/11/2010
Last Update Date : 05/11/2010

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Directions to “MEDICAL ONCOLOGY ASSOCIATES PS ” Practice Location

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