Provider Demographics
NPI:1124337407
Name:INTEGRATED ONCOLOGY NETWORK PLLC
Entity type:Organization
Organization Name:INTEGRATED ONCOLOGY NETWORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-441-9520
Mailing Address - Street 1:8950 S 52ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1046
Mailing Address - Country:US
Mailing Address - Phone:602-441-9520
Mailing Address - Fax:
Practice Address - Street 1:7337 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5603
Practice Address - Country:US
Practice Address - Phone:480-882-6234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ565200Medicaid
AZZ142922Medicare PIN