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General NPI Number Information
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NPI Number | 1033435730
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Entity Type | Organization
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Legal Business Name | VISTA ONCOLOGY INC PS
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 141 LILLY RD NE
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City | OLYMPIA
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State | WA
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Zip | 98506-5028
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Country | US
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Telephone | 360-413-8880
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Fax | 360-350-4838
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Provider Business Mailing Address
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Address Line | 141 LILLY RD NE
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City | OLYMPIA
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State | WA
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Zip | 98506-5028
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Country | US
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Telephone | 360-413-8880
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Fax | 360-350-4838
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. ERIC ZHANG
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Credential | RN
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Telephone | 360-413-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD00043519
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD00043241
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License Number State | WA
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