NPIMap

Organization Active NPI

Cancer Care of North Florida PA

  • Medical Oncology Physician
  • Lake City, FL
National Provider Identifier
1790728947
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
Legal business name
CANCER CARE OF NORTH FLORIDA PA
Practice address
289 SW Stonegate Ter
Suite 103
Lake City, FL 32024-3457
Phone
(386) 755-1655
Fax
(386) 755-2330
NPI assigned
Jun 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Authorized official

Name
Dr. Waseem Khan, M.D.
Title
President
Phone
(386) 755-1655

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology Physician 207RX0202X Primary

Addresses

Primary practice location

289 SW Stonegate Ter
Suite 103
Lake City, FL 32024-3457

Mailing address

PO Box 1642
Lake City, FL 32056-1642
Phone (386) 755-1655

Other identifiers 3

IdentifierTypeStateIssuer
DE8930OtherFLRR MCR
276120300MedicaidFL
39239OtherFLBCBS

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735516800000",
    "number": "1790728947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1642",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320561642",
            "telephone_number": "386-755-1655",
            "fax_number": "386-755-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "289 SW STONEGATE TER",
            "address_2": "SUITE 103",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320243457",
            "telephone_number": "386-755-1655",
            "fax_number": "386-755-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANCER CARE OF NORTH FLORIDA PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "WASEEM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-755-1655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "DE8930",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "276120300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "39239",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; 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.