Provider Demographics
NPI:1851702120
Name:ADVANCED CANCER CARE LLC
Entity Type:Organization
Organization Name:ADVANCED CANCER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADHU
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-771-6135
Mailing Address - Street 1:PO BOX 1249
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-1249
Mailing Address - Country:US
Mailing Address - Phone:727-771-6135
Mailing Address - Fax:727-771-2514
Practice Address - Street 1:34653 US 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2152
Practice Address - Country:US
Practice Address - Phone:727-771-6135
Practice Address - Fax:727-771-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty