Healthcare Provider Details

I. General information

NPI: 1346349321
Provider Name (Legal Business Name): VROM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 S. WOODWORTH LOOP SUITE 150
PALMER AK
99645
US

IV. Provider business mailing address

PO BOX 35146 LB# 196719
SEATTLE WA
98124-2932
US

V. Phone/Fax

Practice location:
  • Phone: 907-745-2900
  • Fax: 907-745-2999
Mailing address:
  • Phone: 907-276-2400
  • Fax: 907-276-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLYN KRAUSE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 907-276-2400