=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255449146
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TACOMA RADIATION ONCOLOGY CENTER INC, PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 10/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1802 YAKIMA AVE STE 103
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98405-5303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-272-1077
-----------------------------------------------------
Fax | 253-627-8792
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4230 BRIDGEPORT WAY W STE B
-----------------------------------------------------
City | UNIVERSITY PLACE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98466-4335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-779-6325
-----------------------------------------------------
Fax | 253-627-8792
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | BETTY RUTH SABLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-779-6331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0203X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Clinic/Center
-----------------------------------------------------
License Number | 601219594
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------