Provider Demographics
NPI:1902851264
Name:GAINESVILLE GYN ONCOLOGY OF NORTH FLORIDA REGIONAL MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:GAINESVILLE GYN ONCOLOGY OF NORTH FLORIDA REGIONAL MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-3375
Mailing Address - Street 1:6400 W NEWBERRY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4384
Mailing Address - Country:US
Mailing Address - Phone:352-333-5946
Mailing Address - Fax:352-333-5947
Practice Address - Street 1:6400 W NEWBERRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4384
Practice Address - Country:US
Practice Address - Phone:352-333-5946
Practice Address - Fax:352-333-5947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73553207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDG1522OtherRAILROAD MEDICARE
FLG57060Medicare UPIN
FLAB597Medicare PIN