Provider Demographics
NPI:1841503885
Name:NORTHERN ARIZONA ONCOLOGY CENTERS LLC
Entity type:Organization
Organization Name:NORTHERN ARIZONA ONCOLOGY CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALVARJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-335-4000
Mailing Address - Street 1:PO BOX 60990
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90060-0990
Mailing Address - Country:US
Mailing Address - Phone:310-335-4000
Mailing Address - Fax:310-335-4098
Practice Address - Street 1:1100 GAIL GARDNER WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1690
Practice Address - Country:US
Practice Address - Phone:928-776-1040
Practice Address - Fax:928-776-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty