MEDICARE: CANCER CENTERS OF CENTRAL FLORIDA 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	207RH0003X	Hematology & Oncology Physician	ME71127	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	31507	OTHER	FL	FLORIDA BLUE

General Provider Information

NPI Number	:	1275514622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANCER CENTERS OF CENTRAL FLORIDA PA

Provider Business Mailing Address
First Line	:	9832 US HIGHWAY 441
Second Line	:	STE 101
City	:	LEESBURG
State	:	FL
Zip	:	34788-3966
Country	:	US
Telephone Number	:	352-787-3341
Fax Number	:	352-787-7491

Provider Business Practice Location Address
First Line	:	9832 US HIGHWAY 441
Second Line	:	STE 101
City	:	LEESBURG
State	:	FL
Zip	:	34788-3966
Country	:	US
Telephone Number	:	352-787-3341
Fax Number	:	352-787-7491

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAMBABU TUMMALA
Credential	:	MD
Telephone Number	:	352-787-3341

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	05/06/2014

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Directions to “CANCER CENTERS OF CENTRAL FLORIDA PA ” Practice Location

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