Basic Information
| Provider Information | |||||||||
| NPI: | 1497083331 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONCOLOGY SERVICES PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MICHAEL L BROWN MD. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 481 | ||||||||
| Address2: | |||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993620013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095252220 | ||||||||
| FaxNumber: | 5095254878 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 W POPLAR ST | ||||||||
| Address2: | |||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993622846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095225700 | ||||||||
| FaxNumber: | 5095254878 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2009 | ||||||||
| LastUpdateDate: | 12/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | PEDERSEN | ||||||||
| AuthorizedOfficialFirstName: | CAROLYN | ||||||||
| AuthorizedOfficialMiddleName: | SUE | ||||||||
| AuthorizedOfficialTitleorPosition: | CLERK | ||||||||
| AuthorizedOfficialTelephone: | 5095252220 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | MD00028934 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1109297 | 05 | WA | MEDICAID | 0187354 | 01 | WA | LABOR AND INDUSTRIES | OTHER | 034186 | 05 | OR | MEDICAID |