1720419955 NPI number — RADIATION THERAPY ASSOCIATES OF WESTERN NORTH CAROLINA PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720419955 NPI number — RADIATION THERAPY ASSOCIATES OF WESTERN NORTH CAROLINA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIATION THERAPY ASSOCIATES OF WESTERN NORTH CAROLINA PA
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:
Provider Other Organization Name Type Code:
6
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:
1720419955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/11/2019
NPI Reactivation Date:
07/19/2019

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2234 COLONIAL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33907-1412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-931-7342
Provider Business Mailing Address Fax Number:
239-931-7385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
CLYDE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28721-8046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-456-7226
Provider Business Practice Location Address Fax Number:
828-456-7274
Provider Enumeration Date:
12/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SHAFMAN
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-456-2690

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com