MEDICARE: RADIATION ONCOLOGY CENTERS OF SOUTHWEST FLORIDA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	L06000059070	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083722789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIATION ONCOLOGY CENTERS OF SOUTHWEST FLORIDA LLC

Provider Business Mailing Address
First Line	:	PO BOX 1450
Second Line	:	NW 5469
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55485-5469
Country	:	US
Telephone Number	:	941-749-0955
Fax Number	:	941-748-7878

Provider Business Practice Location Address
First Line	:	401 MANATEE AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-1143
Country	:	US
Telephone Number	:	941-749-0955
Fax Number	:	941-748-7878

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TRI D. NGUYEN
Credential	:	M.D.
Telephone Number	:	941-749-0955

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	11/13/2008

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