Healthcare Provider Details

I. General information

NPI: 1942575196
Provider Name (Legal Business Name): OKEECHOBEE REGIONAL CANCER CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NE 19TH DR
OKEECHOBEE FL
34972-1911
US

IV. Provider business mailing address

301 NE 19TH DR
OKEECHOBEE FL
34972-1911
US

V. Phone/Fax

Practice location:
  • Phone: 863-357-0039
  • Fax: 863-357-4539
Mailing address:
  • Phone: 863-357-0039
  • Fax: 863-357-4539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD HARLAN WOODY III
Title or Position: PRESIDENT
Credential: MD
Phone: 772-971-3619