Provider Demographics
NPI:1366780660
Name:ROSSINOW RADIATION SERVICES PLLC
Entity type:Organization
Organization Name:ROSSINOW RADIATION SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROSSINOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-441-0008
Mailing Address - Street 1:5150 N 16TH ST
Mailing Address - Street 2:STE B232
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3925
Mailing Address - Country:US
Mailing Address - Phone:602-441-0008
Mailing Address - Fax:866-571-0383
Practice Address - Street 1:5150 N 16TH ST
Practice Address - Street 2:STE B232
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3925
Practice Address - Country:US
Practice Address - Phone:602-441-0008
Practice Address - Fax:866-571-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ420092085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ790667Medicaid
AZZ156415Medicare PIN