Healthcare Provider Details

I. General information

NPI: 1326382482
Provider Name (Legal Business Name): SEATTLE PROTON CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 N 115TH ST
SEATTLE WA
98133-8401
US

IV. Provider business mailing address

192 LEXINGTON AVE 4TH FLOOR
NEW YORK NY
10016-6823
US

V. Phone/Fax

Practice location:
  • Phone: 206-306-2801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number602951848
License Number StateWA

VIII. Authorized Official

Name: MS. ANNIKA ANDREWS
Title or Position: PRESIDENT
Credential:
Phone: 206-306-2801