Healthcare Provider Details

I. General information

NPI: 1396132213
Provider Name (Legal Business Name): LAKE CITY CANCER CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 SW STONEGATE TER SUITE 103
LAKE CITY FL
32024-3456
US

IV. Provider business mailing address

289 SW STONEGATE TER SUITE 103
LAKE CITY FL
32024-3456
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-1655
  • Fax: 386-628-9231
Mailing address:
  • Phone: 386-755-1655
  • Fax: 386-628-9231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberHCC10606
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberHCC10421
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberHCC10421
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberHCC8414
License Number StateFL

VIII. Authorized Official

Name: ROBBIE RHYMER
Title or Position: CFO
Credential:
Phone: 615-467-7415