MEDICARE: 21ST CENTURY 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1770792947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	21ST CENTURY ONCOLOGY LLC

Provider Business Mailing Address
First Line	:	PO BOX 862152
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32886-2152
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	100 MADRID BLVD
Second Line	:	UNIT 112
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-7968
Country	:	US
Telephone Number	:	941-883-0700
Fax Number	:	239-790-5471

Authorized Official
Title or Position	:	CEO
Name	:	KIM COMMINS
Credential	:
Telephone Number	:	239-931-7275

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/12/2019

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