Provider Demographics
NPI:1013311455
Name:COMPREHENSIVE GYNECOLOGIC ONCOLOGY PA
Entity Type:Organization
Organization Name:COMPREHENSIVE GYNECOLOGIC ONCOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANCA
Authorized Official - Middle Name:V
Authorized Official - Last Name:HILDRETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-447-0090
Mailing Address - Street 1:401 LINTON BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-8157
Mailing Address - Country:US
Mailing Address - Phone:561-447-0090
Mailing Address - Fax:561-447-9663
Practice Address - Street 1:401 LINTON BLVD STE 300
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-8157
Practice Address - Country:US
Practice Address - Phone:561-447-0090
Practice Address - Fax:561-447-9663
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE GYNECOLOGIC ONCOLOGY PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800015266291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1683CMedicare PIN