Healthcare Provider Details

I. General information

NPI: 1821085101
Provider Name (Legal Business Name): INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 KINGSLEY AVENUE SUITE 200
ORANGE PARK FL
32073
US

IV. Provider business mailing address

3599 UNIVERSITY BLVD S SUITE 805
JACKSONVILLE FL
32216
US

V. Phone/Fax

Practice location:
  • Phone: 904-276-2303
  • Fax: 904-276-3660
Mailing address:
  • Phone: 904-309-8680
  • Fax: 904-345-5841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. THOMAS A MARSLAND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 904-276-2303