Basic Information
| Provider Information | |||||||||
| NPI: | 1578976379 | ||||||||
| 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: | 1315 S LA CANADA DR | ||||||||
| Address2: | |||||||||
| City: | GREEN VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856221915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206256600 | ||||||||
| FaxNumber: | 5206258467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2014 | ||||||||
| LastUpdateDate: | 01/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | BRANTLEY | ||||||||
| AuthorizedOfficialFirstName: | EV | ||||||||
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| AuthorizedOfficialTitleorPosition: | CASA PRACTICE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5203242462 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 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 | 0359491 | 01 | AZ | NCPDP | OTHER | 289515 | 05 | AZ | MEDICAID |