Integrated Community Oncology Network LLC

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

Legal business name

INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC

Practice address

9 Pine Cone Dr
Suite 108
Palm Coast, FL 32137-8686

Phone

(386) 445-7334

Fax

(386) 445-7389

NPI assigned

Jan 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert J Phelan

Title

Executive Director

Phone

(904) 363-2113

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Cancer Center of Palm Coast Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337817600000",
    "number": "1043365588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9143 PHILIPS HWY",
            "address_2": "SUITE 560",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322561348",
            "telephone_number": "904-363-2113",
            "fax_number": "904-538-3672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 PINE CONE DR",
            "address_2": "SUITE 108",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378686",
            "telephone_number": "386-445-7334",
            "fax_number": "386-445-7389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2012-05-24",
        "status": "A",
        "authorized_official_last_name": "PHELAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "904-363-2113"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273427324",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "94890",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cancer Center of Palm Coast",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Hematology & Oncology Physician in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Hematology & Oncology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.