Basic Information
| Provider Information | |||||||||
| NPI: | 1417345919 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA ONCOLOGY ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1760 E RIVER RD | ||||||||
| Address2: | STE. # 350 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857185877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205197775 | ||||||||
| FaxNumber: | 5205197910 | ||||||||
| Practice Location | |||||||||
| Address1: | 19646 N 27TH AVE | ||||||||
| Address2: | STE. # 406 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850274028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235874868 | ||||||||
| FaxNumber: | 6235829767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2015 | ||||||||
| LastUpdateDate: | 01/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5205197775 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 332900000X | N | Suppliers | Non-Pharmacy Dispensing Site | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 289515 | 05 | AZ | MEDICAID | 0359491 | 01 | AZ | NCPDP | OTHER |