1093948556 NPI number — OCALA ONCOLOGY CENTER PL

Table of content: (NPI 1093948556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093948556 NPI number — OCALA ONCOLOGY CENTER PL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCALA ONCOLOGY CENTER PL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FLORIDA CANCER AFFILIATES-OCALA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093948556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7324 LITTLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW PORT RICHEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34654-5518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-484-7722
Provider Business Mailing Address Fax Number:
727-484-7781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13940 US HWY 441 N.
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
LADY LAKE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32159-8909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-259-8940
Provider Business Practice Location Address Fax Number:
352-430-1073
Provider Enumeration Date:
09/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BALARAMAN
Authorized Official First Name:
RAMA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE PRESIDENT
Authorized Official Telephone Number:
352-732-4032

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 265199802 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DP5758 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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