NPIMap

Organization Active NPI

North Florida Cancer Center Live Oak LLC

  • Radiation Oncology Physician
  • Live Oak, FL
National Provider Identifier
1730176215
Registry record updated Mar 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
NORTH FLORIDA CANCER CENTER LIVE OAK LLC
Practice address
1500 Ohio Ave N
Live Oak, FL 32064-4820
Phone
(386) 362-1174
Fax
(386) 362-1142
NPI assigned
Sep 30, 2005
Last updated
Mar 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2008

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

Authorized official

Name
Mr. Lavelle Hardin
Title
Credentialing Coordinator
Phone
(615) 344-8203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X NU Primary

Addresses

Primary practice location

1500 Ohio Ave N
Live Oak, FL 32064-4820

Mailing address

1500 Ohio Ave N
Live Oak, FL 32064-4820
Phone (386) 362-1174

Other identifiers 1

IdentifierTypeStateIssuer
DD1688OtherFLRR MEDICARE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205798400000",
    "number": "1730176215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 OHIO AVE N",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320644820",
            "telephone_number": "386-362-1174",
            "fax_number": "386-362-1142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 OHIO AVE N",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320644820",
            "telephone_number": "386-362-1174",
            "fax_number": "386-362-1142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH FLORIDA CANCER CENTER LIVE OAK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2008-03-18",
        "status": "A",
        "authorized_official_last_name": "HARDIN",
        "authorized_official_first_name": "LAVELLE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "615-344-8203",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DD1688",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Live Oak, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; 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.