Healthcare Provider Details

I. General information

NPI: 1164810545
Provider Name (Legal Business Name): NORTHWEST CANCER CARE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7379 W DESCHUTES AVE STE 100
KENNEWICK WA
99336-7900
US

IV. Provider business mailing address

7379 W DESCHUTES AVE STE 100
KENNEWICK WA
99336-7900
US

V. Phone/Fax

Practice location:
  • Phone: 509-987-1800
  • Fax: 509-987-1808
Mailing address:
  • Phone: 509-987-1800
  • Fax: 509-987-1808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA SCHROADER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 602-932-8288