Provider Demographics
NPI:1538178066
Name:TUALITY-OHSU CANCER CENTER, LLC
Entity type:Organization
Organization Name:TUALITY-OHSU CANCER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR/TUALITY HEALTHCARE
Authorized Official - Prefix:
Authorized Official - First Name:MANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:503-681-1177
Mailing Address - Street 1:299 SE 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4221
Mailing Address - Country:US
Mailing Address - Phone:503-681-4200
Mailing Address - Fax:503-681-4210
Practice Address - Street 1:299 SE 9TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4221
Practice Address - Country:US
Practice Address - Phone:503-681-4200
Practice Address - Fax:503-681-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR112904Medicare PIN