=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144786906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE HEMATOLOGY ONCOLOGY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2019
-----------------------------------------------------
Last Update Date | 06/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 PARK ST N STE 1017
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33709-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-344-6570
-----------------------------------------------------
Fax | 727-384-4388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3611 LITTLE RD
-----------------------------------------------------
City | TRINITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-312-4300
-----------------------------------------------------
Fax | 727-312-4335
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PRATIBHA KIRIT DESAI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 727-344-6569
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0000X
-----------------------------------------------------
Taxonomy Name | Hematology (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------