Provider Demographics
NPI:1235835216
Name:LAKE CITY CANCER CARE LLC
Entity Type:Organization
Organization Name:LAKE CITY CANCER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP HR & CHIEF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RHYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-467-7415
Mailing Address - Street 1:104 WOODMONT BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:615-783-1071
Mailing Address - Fax:615-783-1082
Practice Address - Street 1:4520 W US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8341
Practice Address - Country:US
Practice Address - Phone:352-755-0601
Practice Address - Fax:352-755-0602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE CITY CANCER CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-01
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015614301Medicaid