Provider Demographics
NPI:1063670255
Name:WOMEN'S CHOICE ONCOLOGY, PLLC
Entity Type:Organization
Organization Name:WOMEN'S CHOICE ONCOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-993-6644
Mailing Address - Street 1:3425 UNIVERSITY PARKWAY
Mailing Address - Street 2:UNIT 102
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-4241
Mailing Address - Country:US
Mailing Address - Phone:941-746-7507
Mailing Address - Fax:941-351-2668
Practice Address - Street 1:3425 UNIVERSITY PARKWAY UNIT 102
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243
Practice Address - Country:US
Practice Address - Phone:941-746-7507
Practice Address - Fax:941-746-7579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-25
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101589207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI14778Medicare UPIN