Healthcare Provider Details

I. General information

NPI: 1033587563
Provider Name (Legal Business Name): IMC-RADIATION ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOBILE INFIRMARY CIR STE G805
MOBILE AL
36607-3513
US

IV. Provider business mailing address

1725 SPRING HILL AVE
MOBILE AL
36604-1402
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-1331
  • Fax:
Mailing address:
  • Phone: 251-435-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY PALAZZO
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 251-435-1331