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NPI Code Detail

MEDICARE: SOUTH COUNTY RADIATION THERAPY, LLC

MEDICARE: SOUTH COUNTY RADIATION THERAPY, 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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841270303
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH COUNTY RADIATION THERAPY, LLC
Provider Business Mailing Address
First Line : 2234 COLONIAL BLVD
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-1412
Country : US
Telephone Number : 239-931-7342
Fax Number : 239-931-7385
Provider Business Practice Location Address
First Line : 142 KENYON AVE
Second Line :
City : WAKEFIELD
State : RI
Zip : 02879-4216
Country : US
Telephone Number : 401-284-0850
Fax Number : 401-284-0860
Authorized Official
Title or Position : CEO
Name : KIM COMMINS
Credential :
Telephone Number : 239-931-7275
Provider Enumeration Date : 01/20/2006
Last Update Date : 07/12/2019

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Directions to “SOUTH COUNTY RADIATION THERAPY, LLC ” Practice Location

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