1851656607 NPI number — CANCER SPECIALISTS, LLC

Table of content: SCOTT MATTHEW FRENGER (NPI 1639952872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851656607 NPI number — CANCER SPECIALISTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANCER SPECIALISTS, 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:
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:
1851656607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7015 AC SKINNER PARKWAY
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-519-2720
Provider Business Mailing Address Fax Number:
904-519-2721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7015 A C SKINNER PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-519-2720
Provider Business Practice Location Address Fax Number:
904-519-2721
Provider Enumeration Date:
07/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PHELAN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
904-519-2720

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PH26314 , 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: 006684800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com