MEDICARE: ROSS CANCER CENTER, 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	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1932546314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSS CANCER CENTER, LLC

Provider Business Mailing Address
First Line	:	508 GOLFPARK DR
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-4626
Country	:	US
Telephone Number	:	407-566-8727
Fax Number	:

Provider Business Practice Location Address
First Line	:	339 CYPRESS PKWY
Second Line	:	SUITE 110
City	:	KISSIMMEE
State	:	FL
Zip	:	34759-3302
Country	:	US
Telephone Number	:	407-566-8727
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. GREGORY ROSS
Credential	:
Telephone Number	:	407-566-8727

Provider Enumeration Date	:	05/27/2013
Last Update Date	:	05/27/2013

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