Provider Demographics
NPI:1437461886
Name:FLORIDA CANCER PHYSICIANS NETWORK LLC
Entity Type:Organization
Organization Name:FLORIDA CANCER PHYSICIANS NETWORK LLC
Other - Org Name:MANATEE CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP INDIANA & S FLORIDA OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA FACHE
Authorized Official - Phone:813-662-6024
Mailing Address - Street 1:2715 W VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6327
Mailing Address - Country:US
Mailing Address - Phone:813-662-6024
Mailing Address - Fax:813-514-1257
Practice Address - Street 1:401 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1143
Practice Address - Country:US
Practice Address - Phone:941-748-4324
Practice Address - Fax:941-748-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDR0495OtherRR MEDICARE
FL0014AOtherBCBS
FL002715005Medicaid
FLDK349BMedicare PIN