Provider Demographics
NPI:1932469152
Name:HOPE RADIATION CANCER CENTER
Entity Type:Organization
Organization Name:HOPE RADIATION CANCER CENTER
Other - Org Name:RADIATION ONCOLOGY SPECIALIST LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:RADIATION ONCOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:HASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURSHED
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS
Authorized Official - Phone:850-481-1687
Mailing Address - Street 1:2900 HWY 77
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5612
Mailing Address - Country:US
Mailing Address - Phone:850-481-1687
Mailing Address - Fax:
Practice Address - Street 1:2900 HWY 77
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-5612
Practice Address - Country:US
Practice Address - Phone:850-481-1687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267670200Medicaid
FL71878WMedicare PIN