MEDICARE: LAKE CITY CANCER CARE 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	207RX0202X	Medical Oncology Physician

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	:	1235835216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE CITY CANCER CARE LLC

Provider Business Mailing Address
First Line	:	104 WOODMONT BLVD STE 500
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-2245
Country	:	US
Telephone Number	:	615-783-1071
Fax Number	:	615-783-1082

Provider Business Practice Location Address
First Line	:	4520 W US HIGHWAY 90
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-8341
Country	:	US
Telephone Number	:	352-755-0601
Fax Number	:	352-755-0602

Authorized Official
Title or Position	:	EVP HR & CHIEF CLINICAL OPERATIONS
Name	:	ROBERT RHYMER
Credential	:
Telephone Number	:	615-467-7415

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	12/30/2024

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Directions to “LAKE CITY CANCER CARE LLC ” Practice Location

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