1255685251 NPI number — HEM ONC ASSOCIATES OF THE TREASURE COAST, PA

Table of content: (NPI 1255685251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255685251 NPI number — HEM ONC ASSOCIATES OF THE TREASURE COAST, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEM ONC ASSOCIATES OF THE TREASURE COAST, 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:
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:
1255685251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1871 SE TIFFANY AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PORT ST LUCIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34952-7596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-335-5666
Provider Business Mailing Address Fax Number:
772-335-3781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 NEBRASKA AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
FORT PIERCE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34950-4704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-464-0880
Provider Business Practice Location Address Fax Number:
772-466-9348
Provider Enumeration Date:
10/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
IANNOTTI
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
OSWALD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
772-335-5666

Provider Taxonomy Codes

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

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





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