1760590962 NPI number — FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC

Table of content: (NPI 1760590962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760590962 NPI number — FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
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 SPECIALISTS P L
Provider Other Organization Name Type Code:
4
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:
1760590962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4371 VERONICA S SHOEMAKER BLVD
Provider Second Line Business Mailing Address:
ATTN: CREDENTIAL DEPT
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33916-2216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-274-8200
Provider Business Mailing Address Fax Number:
239-278-3350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1708 CAPE CORAL PKWY W
Provider Second Line Business Practice Location Address:
#10
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33914-6985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-541-4633
Provider Business Practice Location Address Fax Number:
239-541-1825
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GORDAN
Authorized Official First Name:
LUCIO
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
PRESIDENT/MANAGING PARTNER
Authorized Official Telephone Number:
352-332-3900

Provider Taxonomy Codes

  • Taxonomy code: 207RH0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZC0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZH0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0203X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2540169-38 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2540169-39 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2540169-41 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016902 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016915 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016917 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016919 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2540169-35 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016904 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016918 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016922 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016931 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016934 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016909 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016910 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016912 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254016916 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2540169-42 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2540169-43 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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