Provider Demographics
NPI:1982832390
Name:FLORIDA RADIATION ONCOLOGY PL
Entity Type:Organization
Organization Name:FLORIDA RADIATION ONCOLOGY PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:NORSOPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-899-6223
Mailing Address - Street 1:PO BOX 20085
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-0085
Mailing Address - Country:US
Mailing Address - Phone:813-899-6226
Mailing Address - Fax:813-985-8006
Practice Address - Street 1:3100 E. FLETCHER AVE
Practice Address - Street 2:UCH RADIATION ONCOLOGY DEPARTMENT
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4688
Practice Address - Country:US
Practice Address - Phone:819-971-6000
Practice Address - Fax:813-985-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid