Provider Demographics
NPI:1669669438
Name:TALLAHASSEE CANCER INSTITUTE, PL
Entity Type:Organization
Organization Name:TALLAHASSEE CANCER INSTITUTE, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEMOTOLOGY/ONCOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:AMER
Authorized Official - Middle Name:G
Authorized Official - Last Name:RASSAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-219-8000
Mailing Address - Street 1:1653 MAHAN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5454
Mailing Address - Country:US
Mailing Address - Phone:850-219-8000
Mailing Address - Fax:850-219-8003
Practice Address - Street 1:1653 MAHAN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5454
Practice Address - Country:US
Practice Address - Phone:850-219-8000
Practice Address - Fax:850-219-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9246Medicare PIN