Provider Demographics
NPI:1144900705
Name:CANCER CARE NORTHWEST CENTERS P S
Entity type:Organization
Organization Name:CANCER CARE NORTHWEST CENTERS P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-228-1020
Mailing Address - Street 1:1204 N VERCLER RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1020
Mailing Address - Country:US
Mailing Address - Phone:509-228-1000
Mailing Address - Fax:509-252-9300
Practice Address - Street 1:601 S SHERMAN ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1311
Practice Address - Country:US
Practice Address - Phone:509-228-1000
Practice Address - Fax:509-252-9300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANCER CARE NORTHWEST CENTERS P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site