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
1	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DC6938	OTHER	FL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	94890	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548295850
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	:	1895 KINGSLEY AVE
Second Line	:	SUITE 600
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4466
Country	:	US
Telephone Number	:	904-276-2303
Fax Number	:	904-276-4927

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SHYAM B PARYANI
Credential	:	MD
Telephone Number	:	904-309-8680

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	01/21/2015

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Directions to “INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC ” Practice Location

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