Provider Demographics
NPI:1134145659
Name:ACKERMAN CANCER CENTER, P.A.
Entity Type:Organization
Organization Name:ACKERMAN CANCER CENTER, P.A.
Other - Org Name:FIRST COAST ONCOLOGY, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:N
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-880-5522
Mailing Address - Street 1:1340 S 18TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4799
Mailing Address - Country:US
Mailing Address - Phone:904-277-2700
Mailing Address - Fax:904-277-2220
Practice Address - Street 1:1340 S 18TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4799
Practice Address - Country:US
Practice Address - Phone:904-277-2700
Practice Address - Fax:904-277-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0680444OtherAETNA HMO
FL4643435OtherAETNA PPO
GA300037956EMedicaid
FL253854703Medicaid
FL0680444OtherAETNA HMO
FL77909BMedicare ID - Type UnspecifiedMEDICARE I D NUMBER