NPIMap

Organization Active NPI

Integrated Community Oncology Network,LLC

  • Pharmacy
  • Jacksonville, FL
National Provider Identifier
1487645305
Registry record updated Nov 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
INTEGRATED COMMUNITY ONCOLOGY NETWORK,LLC
Practice address
9143 Philips Hwy
Ste 570
Jacksonville, FL 32256-1348
Phone
(904) 519-2720
Fax
(904) 519-2721
NPI assigned
Oct 31, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2011

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

Authorized official

Name
Robert Phelan
Title
Executive Director
Phone
(904) 363-7442

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X FL Primary

Addresses

Primary practice location

9143 Philips Hwy
Ste 570
Jacksonville, FL 32256-1348

Mailing address

9143 Philips Hwy
Ste 560
Jacksonville, FL 32256-1348
Phone (904) 363-2113

Other identifiers 1

IdentifierTypeStateIssuer
031184700MedicaidFL

Other names 1

  • ICON Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

9143 Philips Hwy
Ste 570
Jacksonville, FL 32256
Phone (904) 519-2720

NPI Registry JSON

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320969600000",
    "number": "1487645305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9143 PHILIPS HWY",
            "address_2": "STE 560",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322561348",
            "telephone_number": "904-363-2113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9143 PHILIPS HWY",
            "address_2": "STE 570",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322561348",
            "telephone_number": "904-519-2720",
            "fax_number": "904-519-2721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED COMMUNITY ONCOLOGY NETWORK,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2011-11-11",
        "status": "A",
        "authorized_official_last_name": "PHELAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "904-363-7442"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031184700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ICON Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2011; 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.