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NPI Code Detail

MEDICARE: NORTH FLORIDA CANCER CENTER TALLAHASSEE LLC

MEDICARE: NORTH FLORIDA CANCER CENTER TALLAHASSEE 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
12085R0001XRadiation Oncology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DD1687OTHERFLRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
121130OTHERFLBCBS OF FL
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952398448
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH FLORIDA CANCER CENTER TALLAHASSEE LLC
Provider Business Mailing Address
First Line : 2003 CENTRE POINTE BLVD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-4893
Country : US
Telephone Number : 850-878-2273
Fax Number : 850-671-5900
Provider Business Practice Location Address
First Line : 2003 CENTRE POINTE BLVD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-4893
Country : US
Telephone Number : 850-878-2273
Fax Number : 850-671-5900
Authorized Official
Title or Position : REGIONAL DIRECTOR
Name : JOAN R GLADNEY
Credential :
Telephone Number : 352-474-6190
Provider Enumeration Date : 09/30/2005
Last Update Date : 05/01/2012

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Directions to “NORTH FLORIDA CANCER CENTER TALLAHASSEE LLC ” Practice Location

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