Central Florida Cancer Institute PA
Organization Active NPI Multi-Specialty Clinic/Center · Lake Wales, FL
NPI 1780923151 · NPPES record last updated Apr 18, 2014
Key facts
- NPI
- 1780923151
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- License
- ME51222 (FL)
- Legal business name
- CENTRAL FLORIDA CANCER INSTITUTE PA
- Practice address
- 2 State Road 60 W
Lake Wales, FL 33853-4118 - Phone
- (863) 679-2960
- Fax
- (863) 679-2781
- NPI assigned
- Feb 5, 2013
- Organization subpart
- No
Authorized official
- Name
- George Martinez
- Title
- Cfo
- Phone
- (407) 566-9899
Practitioners 14
-
Bade Akintan, MD
-
Reginald A Allen, MD
-
Abhijit Vinod Deshmukh, M.D.
-
Randy V Heysek, MD
-
Shivam Kharod, M.D.
-
Eduardo C Moreno, M.D.
-
Kenneth M. Neigut, M.D.
-
Andrew W O'Leary, D.O.
-
Susan Ross, MD
-
Sandra J Sha, MD
-
Michael David Smith, M.D.
-
Aaron O Williams, MD
National Provider Directory
Locations
2 State Road 60 W
Lake Wales, FL 33853
Phone (863) 679-2960
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | ME51222 | FL | Yes |
Addresses
Primary practice location
2 State Road 60 W
Lake Wales, FL 33853-4118
Mailing address
1420 Celebration Blvd
308
Celebration, FL 34747-5159
Phone (407) 566-9899
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 263977700 | Medicaid | FL |
Other providers in Lake Wales, FL
- Caroline C Honculada M D LLC
- Carolyn D Pass PA
- Ardee Tryll Castro
- Gregory Deroan Catrett
- Natalie Caudio
- Central Florida Care Group, Inc.
- Central Florida Health Care, Inc
- Central Florida Health Care, Inc
- Central Florida Health Care, Inc.
- Central Florida Health Care, Inc.
All providers in Lake Wales, FL · Multi-Specialty Clinic/Center in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.