MEDICARE: LEEWARD RADIATION ONCOLOGY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0203X	Radiation Oncology Clinic/Center	RT0002	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457356164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEEWARD RADIATION ONCOLOGY

Provider Business Mailing Address
First Line	:	91-2135 FORT WEAVER RD
Second Line	:	STE B120
City	:	EWA BEACH
State	:	HI
Zip	:	96706-1929
Country	:	US
Telephone Number	:	808-678-9000
Fax Number	:	808-677-1040

Provider Business Practice Location Address
First Line	:	91-2135 FORT WEAVER RD
Second Line	:	STE B120
City	:	EWA BEACH
State	:	HI
Zip	:	96706-1929
Country	:	US
Telephone Number	:	808-678-9000
Fax Number	:	808-677-1040

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	RAE MAMEA
Credential	:
Telephone Number	:	808-678-9000

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	10/14/2008

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Directions to “LEEWARD RADIATION ONCOLOGY ” Practice Location

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