Provider Demographics
NPI:1649420795
Name:21ST CENTURY ONCOLOGY LLC
Entity Type:Organization
Organization Name:21ST CENTURY ONCOLOGY LLC
Other - Org Name:URO-MEDIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOSORETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-931-7200
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:21150 BISCAYNE BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1226
Practice Address - Country:US
Practice Address - Phone:305-446-9111
Practice Address - Fax:305-466-9121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIATION THERAPY SERVICE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-25
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5899310010Medicare NSC