MEDICARE: COMPREHENSIVE HEMATOLOGY ONCOLOGY 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	3336C0003X	Community/Retail Pharmacy

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	:	1528610367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE HEMATOLOGY ONCOLOGY LLC

Provider Business Mailing Address
First Line	:	5000 PARK ST N STE 1025
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2236
Country	:	US
Telephone Number	:	727-344-6569
Fax Number	:	727-384-4388

Provider Business Practice Location Address
First Line	:	5000 PARK ST N STE 1025
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2236
Country	:	US
Telephone Number	:	727-344-6569
Fax Number	:	727-384-4388

Authorized Official
Title or Position	:	CRED
Name	:	JEANINE MARIE MARTIN
Credential	:
Telephone Number	:	352-799-0046

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	07/11/2019

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