Provider Demographics
NPI:1790973063
Name:CANCER SERVICES OF AVENTURA LLC
Entity Type:Organization
Organization Name:CANCER SERVICES OF AVENTURA LLC
Other - Org Name:AVENTURA COMPREHENSIVE CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLADNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-474-6190
Mailing Address - Street 1:20950 NORTH EAST 27TH COURT
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:305-682-2151
Mailing Address - Fax:305-792-5851
Practice Address - Street 1:20950 NE 27TH CT
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1232
Practice Address - Country:US
Practice Address - Phone:305-682-2151
Practice Address - Fax:305-792-5851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN4845OtherRR MEDICARE
FL00575OtherBCBS
FL279822100Medicaid
FLDN4845OtherRR MEDICARE