=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952314635
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PACIFIC ONCOLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 02/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5050 NE HOYT ST STE 362
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97213-2991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-232-7000
-----------------------------------------------------
Fax | 503-232-8266
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15700 SW GREYSTONE CT
-----------------------------------------------------
City | BEAVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97006-6011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-203-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | PATRICIA COSGROVE
-----------------------------------------------------
Credential | RN MSN
-----------------------------------------------------
Telephone | 503-203-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number | 26633
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------