Basic Information
| Provider Information | |||||||||
| NPI: | 1184736340 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONCOLOGY GROUP PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 512 N YOUNG ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993367806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093743915 | ||||||||
| FaxNumber: | 5093748036 | ||||||||
| Practice Location | |||||||||
| Address1: | 7350 W DESCHUTES | ||||||||
| Address2: | BUILDING A | ||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097373371 | ||||||||
| FaxNumber: | 5097360958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | REGE | ||||||||
| AuthorizedOfficialFirstName: | SHEILA | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5093743915 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 7096357 | 05 | WA | MEDICAID |