Provider Demographics
NPI:1962490425
Name:COMPREHENSIVE CANCER CENTERS INC
Entity Type:Organization
Organization Name:COMPREHENSIVE CANCER CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-883-7474
Mailing Address - Street 1:21020 STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1320
Mailing Address - Country:US
Mailing Address - Phone:561-883-7500
Mailing Address - Fax:561-218-6262
Practice Address - Street 1:21020 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1320
Practice Address - Country:US
Practice Address - Phone:561-883-7500
Practice Address - Fax:561-218-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72070Medicare ID - Type Unspecified