MEDICARE: CENTRAL FLORIDA CANCER INSTITUTE PA

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	261QM1300X	Multi-Specialty Clinic/Center	ME51222	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

General Provider Information

NPI Number	:	1235478603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL FLORIDA CANCER INSTITUTE PA

Provider Business Mailing Address
First Line	:	1420 CELEBRATION BLVD
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5159
Country	:	US
Telephone Number	:	407-566-9899
Fax Number	:	407-566-9899

Provider Business Practice Location Address
First Line	:	40107 HIGHWAY 27
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-5901
Country	:	US
Telephone Number	:	863-419-0692
Fax Number	:	863-419-1695

Authorized Official
Title or Position	:	CFO
Name	:	RANDY HEYSEK
Credential	:
Telephone Number	:	407-566-9899

Provider Enumeration Date	:	02/05/2013
Last Update Date	:	12/23/2022

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Directions to “CENTRAL FLORIDA CANCER INSTITUTE PA ” Practice Location

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