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	207RS0012X	Sleep Medicine (Internal Medicine) Physician
2	207RP1001X	Pulmonary Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CE7138	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1841572559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	21ST CENTURY ONCOLOGY LLC

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	1031 SE 9TH PL
Second Line	:	UNIT 2
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3003
Country	:	US
Telephone Number	:	239-573-8448
Fax Number	:	239-573-8604

Authorized Official
Title or Position	:	CEO
Name	:	KIM COMMINS
Credential	:
Telephone Number	:	239-931-7277

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	07/12/2019

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