MEDICARE: SOUTHEASTERN ONCOLOGY ASSOCIATES, PC

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

General Provider Information

NPI Number	:	1578506325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN ONCOLOGY ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	PO BOX 660928
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35266-0928
Country	:	US
Telephone Number	:	205-879-8294
Fax Number	:	205-879-8259

Provider Business Practice Location Address
First Line	:	2018 BROOKWOOD MEDICAL CTR DR
Second Line	:	CANCER CENTER
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6898
Country	:	US
Telephone Number	:	205-877-2339
Fax Number	:	205-877-1821

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	JUDY A CAMPODONICO
Credential	:
Telephone Number	:	205-897-8294

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	08/22/2020

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