Healthcare Provider Details

I. General information

NPI: 1790993632
Provider Name (Legal Business Name): 21ST CENTURY ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 VISCAYA PKWY # 2 SUITE 201
CAPE CORAL FL
33990-3290
US

IV. Provider business mailing address

PO BOX 862152
ORLANDO FL
32886-2152
US

V. Phone/Fax

Practice location:
  • Phone: 239-689-8800
  • Fax: 239-790-5471
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KIM COMMINS
Title or Position: CEO
Credential:
Phone: 239-931-7275