Healthcare Provider Details

I. General information

NPI: 1417360918
Provider Name (Legal Business Name): 21ST CENTURY ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18308 MURDOCK CIR UNIT 105
PORT CHARLOTTE FL
33948-1025
US

IV. Provider business mailing address

2234 COLONIAL BLVD
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 941-743-4150
  • Fax: 941-743-4427
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM COMMINS
Title or Position: CEO
Credential:
Phone: 239-931-7277