Healthcare Provider Details

I. General information

NPI: 1871508564
Provider Name (Legal Business Name): CANCER INSTITUTES OF WASHINGTON, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 CASTLEVALE RD SUITE 201
YAKIMA WA
98902-7807
US

IV. Provider business mailing address

PO BOX 996
HAYDEN ID
83835-0996
US

V. Phone/Fax

Practice location:
  • Phone: 509-454-9499
  • Fax: 509-457-4994
Mailing address:
  • Phone: 208-664-4026
  • Fax: 208-664-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD00044836
License Number StateWA

VIII. Authorized Official

Name: ALBERT MICHAEL BRADY
Title or Position: PHYSICIAN / OWNER
Credential: MD
Phone: 509-454-9499