Provider Demographics
NPI:1386649002
Name:HEYSEK & KEPES MDS PA
Entity Type:Organization
Organization Name:HEYSEK & KEPES MDS PA
Other - Org Name:PLANT CITY CANCER TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-661-6339
Mailing Address - Street 1:407 N PARSONS AVE
Mailing Address - Street 2:STE 103A
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4537
Mailing Address - Country:US
Mailing Address - Phone:813-657-9860
Mailing Address - Fax:813-662-6536
Practice Address - Street 1:303 N ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4303
Practice Address - Country:US
Practice Address - Phone:813-719-7705
Practice Address - Fax:813-719-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40478Medicare PIN