Healthcare Provider Details

I. General information

NPI: 1518285824
Provider Name (Legal Business Name): MEDICAL ONCOLOGY ASSOCIATES PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 N MAYFAIR ST
SPOKANE WA
99208-1129
US

IV. Provider business mailing address

PO BOX 996
HAYDEN ID
83835-0996
US

V. Phone/Fax

Practice location:
  • Phone: 509-462-2273
  • Fax: 509-462-2275
Mailing address:
  • Phone: 208-664-4026
  • Fax: 208-664-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD00046241
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD00037930
License Number StateWA

VIII. Authorized Official

Name: LINDA A DURKIN
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 208-664-4026