Provider Demographics
NPI:1134311624
Name:TREASURE COAST RADIATION ONCOLOGY PA
Entity Type:Organization
Organization Name:TREASURE COAST RADIATION ONCOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIPERSAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-781-5849
Mailing Address - Street 1:2107 SE OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3305
Mailing Address - Country:US
Mailing Address - Phone:772-781-5780
Mailing Address - Fax:
Practice Address - Street 1:2107 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3305
Practice Address - Country:US
Practice Address - Phone:772-781-5780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2008-122-00172085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty