Provider Demographics
NPI:1952398448
Name:NORTH FLORIDA CANCER CENTER TALLAHASSEE LLC
Entity Type:Organization
Organization Name:NORTH FLORIDA CANCER CENTER TALLAHASSEE LLC
Other - Org Name:CAPITAL REGIONAL CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLADNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-474-6190
Mailing Address - Street 1:2003 CENTRE POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4893
Mailing Address - Country:US
Mailing Address - Phone:850-878-2273
Mailing Address - Fax:850-671-5900
Practice Address - Street 1:2003 CENTRE POINTE BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4893
Practice Address - Country:US
Practice Address - Phone:850-878-2273
Practice Address - Fax:850-671-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21130OtherBCBS OF FL
FLDD1687OtherRR MEDICARE
FL272084100Medicaid
FLDD1687OtherRR MEDICARE