Basic Information
| Provider Information | |||||||||
| NPI: | 1467996645 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERIDIAN PARK ONCOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6489 SW BORLAND RD | ||||||||
| Address2: | |||||||||
| City: | TUALATIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970629798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036924843 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6489 SW BORLAND RD | ||||||||
| Address2: | |||||||||
| City: | TUALATIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970629798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036924843 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2016 | ||||||||
| LastUpdateDate: | 12/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | EDGINGTON | ||||||||
| AuthorizedOfficialFirstName: | MELODY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5036924843 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.