Provider Demographics
NPI:1861083438
Name:NEWBURYPORT, MA RADIATION CENTER LLC
Entity type:Organization
Organization Name:NEWBURYPORT, MA RADIATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-544-3215
Mailing Address - Street 1:18201 VON KARMAN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1176
Mailing Address - Country:US
Mailing Address - Phone:800-544-3215
Mailing Address - Fax:
Practice Address - Street 1:1 WALLACE BASHAW WAY STE 1001
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3876
Practice Address - Country:US
Practice Address - Phone:978-997-1351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation