Healthcare Provider Details

I. General information

NPI: 1417086703
Provider Name (Legal Business Name): 21ST CENTURY ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 S TAMIAMI TRL STE 200
SARASOTA FL
34239-5142
US

IV. Provider business mailing address

2160 COLONIAL BLVD
FORT MYERS FL
33907-1410
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8488
  • Fax: 941-917-8475
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN COLLINS
Title or Position: PRESIDENT
Credential:
Phone: 239-931-7275