Provider Demographics
NPI:1447396320
Name:SOUTHEAST CANCER CARE NETWORK LLC
Entity Type:Organization
Organization Name:SOUTHEAST CANCER CARE NETWORK LLC
Other - Org Name:NORTH FLORIDA CANCER CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:SISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUGHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-526-2104
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:DEPT. 2132
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-2132
Mailing Address - Country:US
Mailing Address - Phone:850-526-2101
Mailing Address - Fax:850-482-2445
Practice Address - Street 1:3031 CARTERS MILL RD
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1902
Practice Address - Country:US
Practice Address - Phone:850-526-2101
Practice Address - Fax:850-482-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF7476OtherRAILROAD MEDICARE
FLK8987Medicare ID - Type Unspecified