Healthcare Provider Details

I. General information

NPI: 1770142523
Provider Name (Legal Business Name): PATRIOT ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ARRICOLA AVE
ST AUGUSTINE FL
32080-4515
US

IV. Provider business mailing address

100 ARRICOLA AVE
ST AUGUSTINE FL
32080-4515
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-4368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROY H HINMAN
Title or Position: CEO/CMO
Credential: MD
Phone: 904-825-4368