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NPI Code Detail

MEDICARE: FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC

MEDICARE: FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, 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
1291U00000XClinical Medical Laboratory

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972912632
Entity Type Code : Organization
Provider Name (Legal Business Name) : FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
Provider Business Mailing Address
First Line : 4371 VERONICA S SHOEMAKER BLVD
Second Line : ATTN CREDENTIALING
City : FORT MYERS
State : FL
Zip : 33916-2216
Country : US
Telephone Number : 239-274-8200
Fax Number : 239-278-3350
Provider Business Practice Location Address
First Line : 2848 CENTER POINTE DR STE B
Second Line :
City : FORT MYERS
State : FL
Zip : 33916-9521
Country : US
Telephone Number : 239-561-9622
Fax Number : 239-768-5297
Authorized Official
Title or Position : PRESIDENT
Name : LUCIO NAVARRO GORDAN
Credential :
Telephone Number : 239-274-8200
Provider Enumeration Date : 08/07/2014
Last Update Date : 11/15/2024

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