21St Century Oncology LLC
Organization Active NPI Urology Physician · Sunny Isles Beach, FL
NPI 1326416017 · NPPES record last updated Jul 12, 2019
Key facts
- NPI
- 1326416017
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urology Physician 208800000X
- Legal business name
- 21ST CENTURY ONCOLOGY LLC
- Practice address
- 17070 Collins Ave
Suite 257
Sunny Isles Beach, FL 33160-3635 - Phone
- (305) 534-4747
- Fax
- (305) 937-7726
- NPI assigned
- Sep 11, 2015
- Organization subpart
- Yes
- Parent organization (as reported)
- 21ST CENTURY ONCOLOGY INC
Authorized official
- Name
- Kim Commins
- Title
- Ceo
- Phone
- (239) 931-7277
Parent organization (reported in NPPES) 1
Corporate family (same tax ID) 21
Practitioners 1
-
Carlos A Vidal, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040204000663 | FL | Part B Supplier - Clinic/Group Practice | 9830082882 |
Receives reassigned benefits from 314 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Genesiscare USA of Florida LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician |
208800000X | Yes |
Addresses
Primary practice location
17070 Collins Ave
Suite 257
Sunny Isles Beach, FL 33160-3635
Mailing address
2234 Colonial Blvd
Fort Myers, FL 33907-1412
Phone (239) 931-7342
Other names
- Boris V Klopukh MD
Other providers in Sunny Isles Beach, FL
- 1 Home Care Services LLC
- ABA Therapy Kid Center LLC
- Abelardo Vargas Mdpa
- Abelardo Vargas, M.D.P.a.
- Academia Dental PA
- Roland Adamyan
All providers in Sunny Isles Beach, FL · Urology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.