Healthcare Provider Details

I. General information

NPI: 1992072086
Provider Name (Legal Business Name): VISTA ONCOLOGY INC. PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W K ST
SHELTON WA
98584-2938
US

IV. Provider business mailing address

141 LILLY RD NE
OLYMPIA WA
98506-5028
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-8880
  • Fax: 360-350-4838
Mailing address:
  • Phone: 360-413-8880
  • Fax: 360-350-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC ZHANG
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 360-413-8880