PENINSULA RAD ONC CTR LLC (NPI# 1366694796) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366694796 |
| Entity Type | Organization |
| Organization Name | PENINSULA RAD ONC CTR LLC |
| Other Organization Name | TACOMA RAD ONC CTR INC MBR |
| Practice Address |
11511 Canterwood Blvd Ste 50 Gig Harbor WA 98332-5816 |
| Mailing Address |
4230 Bridgeport Way W Ste B University Place WA 98466-4335 |
| Practice Telephone | 2537796325 |
| Practice Fax Number | 2536278792 |
| Mailing Telephone | 2537796325 |
| Mailing Fax Number | 2536278792 |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2020-09-09 |
| Authorized Official Name | MRS. BETTY SABLE (CFO) |
| Authorized Official Telephone | 2537796325 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians | ||
| Y | 261QR0200X |
Clinic/Center Specialization: Radiology |
WA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7144793 | 05 | |
| WA | L&I CRIME VICTIMS | 8949842 | 01 |
| Other Name | Type Code |
|---|---|
| TACOMA RAD ONC CTR INC MBR | Other Name - Individual/Organization |
| Street Address |
11511 CANTERWOOD BLVD STE 50 |
| City | GIG HARBOR |
| State | WA |
| Zip Code | 98332-5816 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487625851 | Dean G Mastras | Radiology | 11511 Canterwood Blvd Ste 50, Gig Harbor, WA 98332-5816 | 2006-02-01 |
| 1477524841 | Michael J Mcdonough | Radiology | 11511 Canterwood Blvd Ste 50, Gig Harbor, WA 98332-5816 | 2006-02-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023584125 | William Edmondson Wells | Counselor | Wccw, 9601 Bujacick Rd. Nw, Gig Harbor, WA 98332 | 2018-10-17 |
| 1417446758 | Janelle Elizabeth Becker | Physician Assistant | 11511 Canterwood Blvd Nw Ste 205, Gig Harbor, WA 98332 | 2018-05-02 |
| 1205252046 | Jenny Wical | Registered Nurse | 12201 Osprey Dr. Nw, Gig Harbor, WA 98332 | 2014-03-17 |
| 1134486616 | Jacinda Leigh Pickett | Pharmacist | 10990 Harbor Hill Dr, Gig Harbor, WA 98332 | 2012-04-20 |
| 1114242898 | Michael Robert Conger | Urology | 9704 Woodworth Ave Nw, Gig Harbor, WA 98332 | 2010-04-06 |
| 1346473899 | Robert Howard Lerman | Internal Medicine | 9770 44th Ave Nw, Suite 102, Gig Harbor, WA 98332 | 2009-09-01 |
| 1447406699 | Franciscan Health System | General Acute Care Hospital | 11567 Canterwood Blvd, Gig Harbor, WA 98332 | 2008-08-07 |
| 1730303249 | Richard Mason Coyner | Dentist | 7715 Pioneer Way, Gig Harbor, WA 98332 | 2007-04-13 |
| 1902978711 | Byron D Fenton | Chiropractor | 14619 Purdy Dr, Gig Harbor, WA 98332 | 2006-11-15 |
| 1063515351 | Gordon Bernstein | Radiology | 5304 W Old Stump Dr Nw, Gig Harbor, WA 98332 | 2006-09-05 |
| Find all providers in zip 98332 | ||||
| Taxonomy Code | 261QR0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811431752 | Bows-r-bowties | Clinic/Center | 646 Strander Blvd, Tukwila, WA 98188-2923 | 2016-12-12 |
| 1861775249 | 3d Imaging and Diagnosis LLC | Clinic/Center | 5340 Corporate Center Loop Se Ste A, Lacey, WA 98503-5590 | 2011-09-22 |
| 1073773198 | Providence Everett Medical Center | Clinic/Center | 4112 Harbour Pointe Blvd, Suite 100, Mukilteo, WA 98275-4700 | 2008-06-12 |
| 1285850461 | Brain Matters Imaging Centers | Clinic/Center | 1015 8th Ave North, Seattle, WA 98109-3504 | 2007-04-17 |
| 1790822070 | Advanced Open Imaging LLC | Clinic/Center | 19401 40th Ave West, Suite 140, Lynnwood, WA 98036 | 2007-01-30 |
| 1184790032 | Tra-minw, Ps | Clinic/Center | 34515 9th Ave. South, Federal Way, WA 98003 | 2006-11-24 |
| 1356416705 | Peninsula Medical Imaging, Pllc | Clinic/Center | 675 N. Fifth Ave, Suite 2b, Sequim, WA 98382-3201 | 2006-11-21 |
| 1396814166 | Tra-minw, Ps | Clinic/Center | 2502 S Union Ave, Tacoma, WA 98405-1328 | 2006-11-07 |
| 1588775662 | Lynden Medical X-ray LLC | Clinic/Center | 9310 Hammer Rd, Lynden, WA 98264-9530 | 2006-08-31 |
| 1093750614 | Valley Imaging | Clinic/Center | 314 S 11th Ave, Ste B, Yakima, WA 98902-3214 | 2006-06-18 |
| Find all providers with the same taxonomy | ||||
| City | GIG HARBOR |
| Zip Code | 98332 |
Please comment or provide details below to improve the information on PENINSULA RAD ONC CTR LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.