Provider Demographics
NPI:1720198542
Name:RADIATION ONCOLOGY CENTERS OF SOUTHWEST FLORIDA, LLC
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY CENTERS OF SOUTHWEST FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRI
Authorized Official - Middle Name:D
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-795-2270
Mailing Address - Street 1:1128 PALMA SOLA BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3342
Mailing Address - Country:US
Mailing Address - Phone:941-795-2270
Mailing Address - Fax:
Practice Address - Street 1:601 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8610
Practice Address - Country:US
Practice Address - Phone:941-795-2270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME347082085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty