Provider Demographics
NPI:1275917304
Name:21ST CENTURY ONCOLOGY LLC
Entity Type:Organization
Organization Name:21ST CENTURY ONCOLOGY LLC
Other - Org Name:GULFSHORE UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:COMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-931-7277
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:4571 COLONIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1156
Practice Address - Country:US
Practice Address - Phone:239-322-5600
Practice Address - Fax:239-322-5610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:21ST CENTURY ONCOLOGY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-18
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty