Healthcare Provider Details

I. General information

NPI: 1053649475
Provider Name (Legal Business Name): CLACKAMAS RADIATION ONCOLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9280 SE SUNNYBROOK BLVD SUITE 100
CLACKAMAS OR
97015-6899
US

IV. Provider business mailing address

PO BOX 3867
PORTLAND OR
97208-3867
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-1837
  • Fax: 503-215-3687
Mailing address:
  • Phone: 503-215-8584
  • Fax: 503-215-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ALICE WANG-CHESEBRO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 503-513-3300