Provider Demographics
NPI:1205882867
Name:HEM ONC ASSOCIATES OF THE TREASURE COAST, PA
Entity type:Organization
Organization Name:HEM ONC ASSOCIATES OF THE TREASURE COAST, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:IANNOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-335-5666
Mailing Address - Street 1:1871 S.E. TIFFANY AVENUE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7596
Mailing Address - Country:US
Mailing Address - Phone:772-335-5666
Mailing Address - Fax:772-335-3781
Practice Address - Street 1:1871 S.E. TIFFANY AVENUE
Practice Address - Street 2:SUITE #100
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7596
Practice Address - Country:US
Practice Address - Phone:772-335-5666
Practice Address - Fax:772-335-3781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251297100Medicaid
FL40806OtherMEDICARE PTAN
FL40806OtherBS/FL
FL251297100Medicaid
FL40806Medicare PIN
FLE21804Medicare UPIN
FL064733100Medicaid
FL254047900Medicaid
FL047329400Medicaid
FL56158YMedicare ID - Type Unspecified
FLD79545Medicare UPIN
FL08210YMedicare ID - Type Unspecified
FL251297100Medicaid
FLF73315Medicare UPIN
FLD65160Medicare UPIN