NPIMap

Organization Active NPI

Coos Radiosurgery Group LLC

  • Radiation Oncology Physician
  • Coos Bay, OR
National Provider Identifier
1710480397
Registry record updated Mar 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
COOS RADIOSURGERY GROUP LLC
Practice address
1775 Thompson Rd
Coos Bay, OR 97420-2125
Phone
(541) 269-8520
NPI assigned
Mar 9, 2018
Last updated
Mar 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brian G Fuller, MDNPI 1396834412
Title
Manager
Phone
(301) 529-7222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

1775 Thompson Rd
Coos Bay, OR 97420-2125

Mailing address

PO Box 398974
San Francisco, CA 94139-8974

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521676800000",
    "number": "1710480397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 398974",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941398974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 THOMPSON RD",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202125",
            "telephone_number": "541-269-8520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOS RADIOSURGERY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-09",
        "last_updated": "2018-03-22",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "301-529-7222",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coos Bay, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.