Healthcare Provider Details

I. General information

NPI: 1811923386
Provider Name (Legal Business Name): BARDMOOR CANCER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 BRYAN DAIRY RD SUITE 120
LARGO FL
33777-1251
US

IV. Provider business mailing address

104 WOODMONT BLVD STE 500
NASHVILLE TN
37205-2245
US

V. Phone/Fax

Practice location:
  • Phone: 727-320-0200
  • Fax:
Mailing address:
  • Phone: 888-802-9885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTIN C. HARLAN
Title or Position: EVP, CFO
Credential:
Phone: 615-252-7202