1891166971 NPI number — 21ST CENTURY ONCOLOGY LLC

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 1891166971 NPI number — 21ST CENTURY ONCOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
21ST CENTURY ONCOLOGY 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:
THE DONOWAY CENTER FOR CANCER TREATMENT AND PREVENTION
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:
1891166971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

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:
4000 HOLLYWOOD BLVD
Provider Second Line Business Practice Location Address:
PRESIDENTIAL CIRCLE - SUITE 160 NORTH
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33021-6751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-986-6366
Provider Business Practice Location Address Fax Number:
954-986-4355
Provider Enumeration Date:
10/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
COMMINS
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
239-931-7277

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 281173134 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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