MEDICARE: MERIDIAN PARK RADIATION ONCOLOGY CENTER, INC.

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

General Provider Information

NPI Number	:	1538330899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN PARK RADIATION ONCOLOGY CENTER, INC.

Provider Business Mailing Address
First Line	:	6489 SW BORLAND RD
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062
Country	:	US
Telephone Number	:	503-692-4843
Fax Number	:	503-692-6543

Provider Business Practice Location Address
First Line	:	6489 SW BORLAND RD
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-9798
Country	:	US
Telephone Number	:	503-692-4843
Fax Number	:	503-692-6543

Authorized Official
Title or Position	:	OWNER MANAGER
Name	:	MR. ROBERT J MILLER
Credential	:
Telephone Number	:	503-692-4843

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	04/28/2008

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