1932564978 NPI number — FLORIDA RADIATION ONCOLOGY PARTNERS

Table of content: (NPI 1932564978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932564978 NPI number — FLORIDA RADIATION ONCOLOGY PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA RADIATION ONCOLOGY PARTNERS
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:
1932564978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
483 N SEMORAN BLVD
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32792-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-539-0722
Provider Business Mailing Address Fax Number:
407-539-0723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
483 N SEMORAN BLVD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32792-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-539-0722
Provider Business Practice Location Address Fax Number:
407-539-0723
Provider Enumeration Date:
12/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
ROCHELLE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
407-215-6320

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , 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: 018792400 . 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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