Provider Demographics
NPI:1699136689
Name:ON SITE HEPATOLOGY CORP
Entity type:Organization
Organization Name:ON SITE HEPATOLOGY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR BUSINESS DEVELOPMEN
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-480-5056
Mailing Address - Street 1:9578 E HIDDEN HILL LN # 200
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5408
Mailing Address - Country:US
Mailing Address - Phone:720-480-5056
Mailing Address - Fax:303-362-1499
Practice Address - Street 1:7345 LINDERSON WAY SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6504
Practice Address - Country:US
Practice Address - Phone:360-725-8213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603 577 631261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile