Basic Information
| Provider Information | |||||||||
| NPI: | 1740201912 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH FLORIDA RADIATION ONCOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6420 NEWBERRY ROAD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523335840 | ||||||||
| FaxNumber: | 3523335841 | ||||||||
| Practice Location | |||||||||
| Address1: | 6420 NEWBERRY ROAD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523335840 | ||||||||
| FaxNumber: | 3523335841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | TURNER | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3523335850 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0203X | N | Ambulatory Health Care Facilities | Clinic/Center | Oncology, Radiation | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 97370 | 01 | FL | BCBS OF FL | OTHER | DF3627 | 01 | RR MEDICARE | OTHER | 276396600 | 05 | FL | MEDICAID |