Provider Demographics
NPI:1568750644
Name:FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
Entity Type:Organization
Organization Name:FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
Other - Org Name:FLORIDA CANCER SPECIALISTS P L
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCIO
Authorized Official - Middle Name:NAVARRO
Authorized Official - Last Name:GORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-274-8200
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:805 CURRENCY CIR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2115
Practice Address - Country:US
Practice Address - Phone:407-804-6133
Practice Address - Fax:866-447-9143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2540169-47Medicaid
FL1310760041Medicare NSC
FL2540169-47Medicaid