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General NPI Number Information
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NPI Number | 1346561289
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Entity Type | Organization
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Legal Business Name | 21ST CENTURY ONCOLOGY LLC
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 131 E REDSTONE AVE SUITE 102
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City | CRESTVIEW
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State | FL
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Zip | 32539-5326
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Country | US
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Telephone | 850-682-6333
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Fax | 850-682-0865
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Provider Business Mailing Address
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Address Line | 2234 COLONIAL BLVD
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City | FORT MYERS
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State | FL
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Zip | 33907-1412
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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Authorized Official
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Title or Position | SR. DIRECTOR OF PROVIDER RELATIONS
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Name | DIANNA HARRISON
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Credential |
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Telephone | 239-931-7342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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