Provider Demographics
NPI:1083722789
Name:RADIATION ONCOLOGY CENTERS OF SOUTHWEST FLORIDA LLC
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY CENTERS OF SOUTHWEST FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRI
Authorized Official - Middle Name:D
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-749-0955
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:NW 5469
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55485-5469
Mailing Address - Country:US
Mailing Address - Phone:941-749-0955
Mailing Address - Fax:941-748-7878
Practice Address - Street 1:401 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1143
Practice Address - Country:US
Practice Address - Phone:941-749-0955
Practice Address - Fax:941-748-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL060000590702085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049060100Medicaid
FL276514400Medicaid
FL044535500Medicaid
FL058657900Medicaid
FL039743100Medicaid
AC167Medicare PIN