Provider Demographics
NPI:1750175501
Name:ACKERMAN CANCER CENTER, PA
Entity type:Organization
Organization Name:ACKERMAN CANCER CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-880-5522
Mailing Address - Street 1:PO BOX 37016
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33631-9016
Mailing Address - Country:US
Mailing Address - Phone:904-880-5522
Mailing Address - Fax:
Practice Address - Street 1:520 W TWINCOURT TRL STE 4-5
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8987
Practice Address - Country:US
Practice Address - Phone:904-880-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACKERMAN CANCER CENTER, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty