Basic Information
| Provider Information | |||||||||
| NPI: | 1013954858 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COCHISE ONCOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1418 | ||||||||
| Address2: | |||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856361418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208036644 | ||||||||
| FaxNumber: | 5204593193 | ||||||||
| Practice Location | |||||||||
| Address1: | 5151 E HIGHWAY 90 | ||||||||
| Address2: | |||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856352436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208036644 | ||||||||
| FaxNumber: | 5204593193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 02/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | NETTLETON | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5205593684 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 2085R0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.