1497752729 NPI number — CENTER FOR RADIATION ONCOLOGY OF TAMPA BAY IN

Table of content: (NPI 1497752729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497752729 NPI number — CENTER FOR RADIATION ONCOLOGY OF TAMPA BAY IN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR RADIATION ONCOLOGY OF TAMPA BAY IN
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:
1497752729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2715 WEST VIRGINIA AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33607-6327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-662-6024
Provider Business Mailing Address Fax Number:
813-514-1257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
717 W ROBERTSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33511-4921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-661-6339
Provider Business Practice Location Address Fax Number:
813-661-6442
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
NICK
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VP INDIANA AND SOUTH FLORIDA OPERAI
Authorized Official Telephone Number:
813-662-6024

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  27091 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 264462200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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