Healthcare Provider Details

I. General information

NPI: 1811008220
Provider Name (Legal Business Name): KITSAP RADIATION ONCOLOGY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 CHERRY AVE
BREMERTON WA
98310-4229
US

IV. Provider business mailing address

PO BOX 84251
SEATTLE WA
98124-5551
US

V. Phone/Fax

Practice location:
  • Phone: 512-583-2004
  • Fax: 360-475-8542
Mailing address:
  • Phone: 360-744-8545
  • Fax: 360-744-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number28700
License Number StateWA

VIII. Authorized Official

Name: DR. STEPHEN CHARLES SPRINGATE
Title or Position: MD OWNER
Credential: M.D.
Phone: 360-475-8545