21St Century Oncology LLC
Organization Active NPI Urology Physician · Crestview, FL
NPI 1346561289 · NPPES record last updated Feb 3, 2025
Key facts
- NPI
- 1346561289
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urology Physician 208800000X
- Legal business name
- 21ST CENTURY ONCOLOGY LLC
- Practice address
- 131 E Redstone Ave
Suite 102
Crestview, FL 32539-5326 - Phone
- (850) 682-6333
- Fax
- (850) 682-0865
- NPI assigned
- Jun 15, 2010
- Organization subpart
- Yes
- Parent organization (as reported)
- RADIATION THERAPY SERVICES INC
Authorized official
- Name
- Dianna Harrison
- Title
- Sr. Director of Provider Relations
- Phone
- (239) 931-7342
Practitioners 5
-
Yan G Makeyev, MD
-
Ted Chung, M.D.
-
Kapil Puri, M.D.
-
Thomas Zachos, 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
Locations
155 Crystal Beach Dr
Ste 120
Destin, FL 32541
Phone (850) 837-0576
1112 Hospital Rd
Unit A
Ft Walton Bch, FL 32547
Phone (850) 682-6333
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician |
208800000X | Yes | ||
| General Practice Physician |
208D00000X |
Addresses
Primary practice location
131 E Redstone Ave
Suite 102
Crestview, FL 32539-5326
Mailing address
2234 Colonial Blvd
Fort Myers, FL 33907-1412
Phone (239) 931-7342
Other names
- Okaloosa-Walton Urology
Other providers in Crestview, FL
- 500 Hospital Dr Opco LLC
- 500 South Hospital Drive Operations LLC
- 850 Therapy, LLC
- A-1 Transportation & Shuttle Services LLC
- Aaron B Stein MD PLLC
All providers in Crestview, 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 Feb 3, 2025. 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.