MEDICARE: COMPREHENSIVE CANCER CENTERS INC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1962490425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE CANCER CENTERS INC

Provider Business Mailing Address
First Line	:	21020 STATE ROAD 7
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1320
Country	:	US
Telephone Number	:	561-883-7500
Fax Number	:	561-218-6262

Provider Business Practice Location Address
First Line	:	21020 STATE ROAD 7
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1320
Country	:	US
Telephone Number	:	561-883-7500
Fax Number	:	561-218-6262

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. TOM LONG
Credential	:
Telephone Number	:	561-883-7474

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	02/28/2008

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