Basic Information
| Provider Information | |||||||||
| NPI: | 1114019684 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERIDIAN PARK RADIATION ONCOLOG CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6489 SW BORLAND RD | ||||||||
| Address2: | |||||||||
| City: | TUALATIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970629798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036924843 | ||||||||
| FaxNumber: | 5036926543 | ||||||||
| Practice Location | |||||||||
| Address1: | 6489 SW BORLAND RD | ||||||||
| Address2: | |||||||||
| City: | TUALATIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036924843 | ||||||||
| FaxNumber: | 5036926543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 08/08/2018 | ||||||||
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| AuthorizedOfficialLastName: | EDGINGTON | ||||||||
| AuthorizedOfficialFirstName: | MELODY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5036824843 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0203X | Y | Ambulatory Health Care Facilities | Clinic/Center | Oncology, Radiation |
No ID Information.