Integrated Community Oncology Network LLC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

ME59868 Issued in FL

Legal business name

INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC

Practice address

1715 Village Way
Orange Park, FL 32073-5263

Phone

(904) 264-8418

Fax

(904) 264-9692

NPI assigned

Feb 2, 2010

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 names 1

• Urology Associates of Northeast Florida Doing business as

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

{
    "created_epoch": "1265068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265068800000",
    "number": "1720310733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9143 PHILIPS HWY STE 560",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322561369",
            "telephone_number": "904-363-7453",
            "fax_number": "904-538-3672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 VILLAGE WAY",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735263",
            "telephone_number": "904-264-8418",
            "fax_number": "904-264-9692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-02",
        "last_updated": "2010-02-02",
        "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": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": "FL",
            "license": "ME59868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Urology Associates of Northeast Florida",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Integrated Community Oncology Network LLC
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• Integrated Community Oncology Network LLC
• Integrated Regional Laboratories Pathology Services, LLC
• Integrative Social Services LLC
• Integrity Home Health, PLLC

• Urology Physician in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Urology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2010; 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.