Organization
COMMUNITY CANCER FOUNDATION
Active
Other names
Community Cancer Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TAMMY HAGEDORN (EXECUTIVE DIRECTOR)
(541) 673-2267
Entity
Organization
Contact information
Practice address
2880 NW STEWART PKWY, SUITE 100, ROSEBURG, OR 97471-1201
(541) 673-2267
(541) 672-9483
Mailing address
2880 NW STEWART PKWY, SUITE 100, ROSEBURG, OR 97471-1201
(541) 673-2267
(541) 672-9483
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QX0203X
Radiation Oncology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000773
—
OR
01
—
002524000
REGENCE BCBS OF OREGON
OR
01
—
4308388
REGENCE BCBS PC65
OR
Enumeration date
07/27/2005
Last updated
02/03/2020
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