Healthcare Provider Details

I. General information

NPI: 1144404310
Provider Name (Legal Business Name): CAPITAL ONCOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BISHOP ROAD
CHEHALIS WA
98532
US

IV. Provider business mailing address

3920 CAPITOL MALL DR SW SUITE 100
OLYMPIA WA
98502-8700
US

V. Phone/Fax

Practice location:
  • Phone: 360-767-0115
  • Fax:
Mailing address:
  • Phone: 360-753-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name: DR. DUSTIN C OSBORN
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D., PHD
Phone: 360-753-4700