Provider Demographics
NPI:1326201591
Name:ST PETE CANCER TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:ST PETE CANCER TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MD
Authorized Official - Phone:866-212-7009
Mailing Address - Street 1:6449 38TH AVENUE
Mailing Address - Street 2:SUITE C3-D3
Mailing Address - City:NORTH ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710
Mailing Address - Country:US
Mailing Address - Phone:866-212-7009
Mailing Address - Fax:321-383-3101
Practice Address - Street 1:6449 38TH AVENUE
Practice Address - Street 2:SUITE C3-D3
Practice Address - City:NORTH ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710
Practice Address - Country:US
Practice Address - Phone:866-212-7009
Practice Address - Fax:321-383-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation