Provider Demographics
NPI:1427139120
Name:RADIATION THERAPY CONSULTANTS, PC
Entity type:Organization
Organization Name:RADIATION THERAPY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-561-5135
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-0391
Mailing Address - Country:US
Mailing Address - Phone:503-561-5135
Mailing Address - Fax:503-561-6807
Practice Address - Street 1:875 OAK ST SE STE 1080
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3977
Practice Address - Country:US
Practice Address - Phone:503-561-5135
Practice Address - Fax:503-561-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR002881Medicaid
OR002881Medicaid