Basic Information
| Provider Information | |||||||||
| NPI: | 1659003648 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH FLORIDA RADIATION ONCOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 795 SW STATE ROAD 47 | ||||||||
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| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320250453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867587822 | ||||||||
| FaxNumber: | 3867582224 | ||||||||
| Practice Location | |||||||||
| Address1: | 795 SW STATE ROAD 47 | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320250453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867587822 | ||||||||
| FaxNumber: | 3867582224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2022 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | TURNER | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3523335850 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTH FLORIDA RADIATION ONCOLOGY LLC | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 109506100 | 05 | FL | MEDICAID |