Provider Demographics
NPI:1518024934
Name:UVA CANCER CENTER GAINESVILLE, LLC
Entity Type:Organization
Organization Name:UVA CANCER CENTER GAINESVILLE, LLC
Other - Org Name:UVA CANCER CENTER GAINESVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:CODER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-835-2069
Mailing Address - Street 1:PO BOX 800750
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0750
Mailing Address - Country:US
Mailing Address - Phone:434-924-8344
Mailing Address - Fax:
Practice Address - Street 1:7901 LAKE MANASSAS DR
Practice Address - Street 2:
Practice Address - City:GAINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155
Practice Address - Country:US
Practice Address - Phone:703-753-4045
Practice Address - Fax:703-753-8037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10084Medicare PIN
C10084Medicare UPIN
VAC10084Medicare PIN