Basic Information
| Provider Information | |||||||||
| NPI: | 1104082577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CANCER CARE OF SOUTHERN OREGON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 748 STATE ST | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417725282 | ||||||||
| FaxNumber: | 5412822237 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 DOCTORS PARK DR | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412822208 | ||||||||
| FaxNumber: | 5412822237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2008 | ||||||||
| LastUpdateDate: | 08/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | FLINN | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5412822208 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ROGUE VALLEY PHYSICIANS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.