Basic Information
| Provider Information | |||||||||
| NPI: | 1245663319 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COCHISE MEDICAL ONCOLOGY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5151 E HIGHWAY 90 | ||||||||
| Address2: | |||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856352436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208036644 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5151 E HIGHWAY 90 | ||||||||
| Address2: | |||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856352436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208036644 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2013 | ||||||||
| LastUpdateDate: | 10/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | NETTLETON | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5208036644 | ||||||||
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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 | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.