Healthcare Provider Details

I. General information

NPI: 1265860027
Provider Name (Legal Business Name): VISTA ONCOLOGY INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 MCPHEE RD SE
OLYMPIA WA
98502
US

IV. Provider business mailing address

420 MCPHEE RD SW SUITE A
OLYMPIA WA
98502-5014
US

V. Phone/Fax

Practice location:
  • Phone: 360-352-2900
  • Fax: 360-352-2916
Mailing address:
  • Phone: 360-352-2900
  • Fax: 360-352-2916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC ZHANG
Title or Position: BUSINESS MANAGER
Credential:
Phone: 360-413-8880