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NPI Code Detail

MEDICARE: INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC

MEDICARE: INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DC6938OTHERFLMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
394890OTHERFLBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1518986926
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC
Provider Business Mailing Address
First Line : PO BOX 19675
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32245-9675
Country : US
Telephone Number : 904-309-8680
Fax Number : 904-345-5847
Provider Business Practice Location Address
First Line : 600 ZEAGLER DR
Second Line : SUITE 2
City : PALATKA
State : FL
Zip : 32177-3811
Country : US
Telephone Number : 386-325-8140
Fax Number : 904-350-0032
Authorized Official
Title or Position : DIRECTOR
Name : SHYAM B PARYANI
Credential : MD
Telephone Number : 904-309-8680
Provider Enumeration Date : 07/18/2006
Last Update Date : 01/21/2015

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Directions to “INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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