NPIMap

Organization Active NPI

North Florida Cancer Center Lake City LLC

Doing business as The Cancer Center at Lake City

  • Radiation Oncology Physician
  • Lake City, FL
National Provider Identifier
1902893902
Registry record updated May 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
NORTH FLORIDA CANCER CENTER LAKE CITY LLC
Doing business as
The Cancer Center at Lake City
Practice address
795 SW Highway 47
Lake City, FL 32025
Phone
(386) 758-7822
Fax
(386) 758-2224
NPI assigned
Oct 4, 2005
Last updated
May 1, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2012

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

Authorized official

Name
Joan R Gladney
Title
Regional Director
Phone
(352) 474-6190

Specialties & licenses 1

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

Addresses

Primary practice location

795 SW Highway 47
Lake City, FL 32025

Mailing address

795 SW State Road 47
Lake City, FL 32025-0453
Phone (386) 758-7822

Other identifiers 3

IdentifierTypeStateIssuer
272085000MedicaidFL
74629OtherFLBCBS
DD1689OtherFLRR MEDICARE

Other names 1

  • The Cancer Center at Lake City Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335830400000",
    "number": "1902893902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 SW STATE ROAD 47",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320250453",
            "telephone_number": "386-758-7822",
            "fax_number": "386-758-2224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 SW HIGHWAY 47",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "32025",
            "telephone_number": "386-758-7822",
            "fax_number": "386-758-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH FLORIDA CANCER CENTER LAKE CITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2012-05-01",
        "status": "A",
        "authorized_official_last_name": "GLADNEY",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR",
        "authorized_official_telephone_number": "352-474-6190"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272085000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "74629",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DD1689",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Cancer Center at Lake City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 1, 2012; 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.