MEMORIAL SOUTHSIDE CANCER CENTER LLC


Address: 5742 Booth Rd, Suite B, Jacksonville, FL 32207
Phone: 9046366911

MEMORIAL SOUTHSIDE CANCER CENTER LLC (NPI# 1588724033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1588724033
Entity Type Organization
Organization Name MEMORIAL SOUTHSIDE CANCER CENTER LLC
Other Organization Name MEMORIAL CANCER CENTER
Practice Address 5742 Booth Rd
Suite B
Jacksonville
FL 32207
Practice Telephone 9046366911
Practice Fax Number 9046366330
Mailing Telephone 9046366911
Mailing Fax Number 9046366330
Enumeration Date 2006-12-12
Last Update Date 2010-01-27
Authorized Official Name MR. LAVELLE HARDIN (CREDENTIALING COORDINATOR)
Authorized Official Telephone 6153448203
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QX0203X Clinic/Center
Specialization: Oncology, Radiation
APPLYING FL Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
FL 277325200 05
FL BCBS OF FL 00389 01
FL RR MEDICARE DG1361 01

Other Provider/Organization Names

Other Name Type Code
Memorial Cancer Center Doing Business As Name - Organization

Office Location

Street Address 5742 BOOTH RD
SUITE B
City JACKSONVILLE
State FL
Zip Code 32207

Providers in the same location

NPI Name Taxonomy Address Enumeration
1306841622 Jaswant S Jadeja Internal Medicine 5742 Booth Rd, Jacksonville, FL 32207-5905 2005-06-14
1396176111 Angela Irene Mays Nurse Practitioner 5742 Booth Rd, Suite A, Jacksonville, FL 32207-5982 2013-12-04
1801148473 Cancer Specialists LLC Durable Medical Equipment & Medical Supplies 5742 Booth Rd, Suite A, Jacksonville, FL 32207-5982 2012-10-08
1023389806 Meredith Hughes Harlow Social Worker 5742 Booth Rd, Suite A, Jacksonville, FL 32207-5982 2012-01-25
1790935153 Bijoy Pankaj Telivala Internal Medicine 5742 Booth Rd, Suite A, Jacksonville, FL 32207-5982 2008-09-23
1568619716 Kelli K Colson Nurse Practitioner 5742 Booth Rd, Jacksonville, FL 32207-5982 2008-08-19
1245345438 Aref A Badr Nuclear Medicine 5742 Booth Rd, Ste B, Jacksonville, FL 32207-5982 2006-08-20
1043230402 Integrated Community Oncology Network LLC Radiology 5742 Booth Rd, Suite B, Jacksonville, FL 32207-5982 2006-07-20
1093752826 Sejal S Kuthiala Internal Medicine 5742 Booth Rd, Suite A, Jacksonville, FL 32207-5982 2006-06-01
1508824608 Larry H Wilf Specialist 5742 Booth Rd, Suite B, Jacksonville, FL 32207-5982 2006-05-01
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1033768981 North Florida Pediatrics, Pa Pediatrics 4501 Atlantic Boulevard, Jacksonville, FL 32207 2019-09-04
1578117024 Pragna Mukesh Dholakia Nurse Practitioner 2624 Atlantic Blvd., Jacksonville, FL 32207 2019-08-01
1821653601 The Adoption Authority, Inc. Case Management 4940 Emerson Street, Suite 103, Jacksonville, FL 32207 2019-05-07
1255896080 Elizabeth Lynn Houghton Social Worker Sulzbacher Village, 904-720-2079, Jacksonville, FL 32207 2019-02-06
1902374630 Guilherme Jose Agnoletto Neurological Surgery 800 Prudential Drive Weaver Tower 11th Floor, Jacksonville, FL 32207 2018-11-12
1073008504 Pavilion Infusion Therapy Inc Durable Medical Equipment & Medical Supplies 1301 Palm Avenue, Suite 220, Jacksonville, FL 32207 2018-06-27
1346733185 Dueseason1 Registered Nurse 4058 Saint Augustine Rd, Jacksonville, FL 32207 2018-06-06
1164911913 Eric Lang Poovey Nurse Practitioner Baptist Heart Specialists, 836 Prudential Drive Suite 1700, Jacksonville, FL 32207 2018-05-08
1902311046 Spring Park Pharmacy LLC Durable Medical Equipment & Medical Supplies 3851 Emerson St Ste 13, Jacksonville, FL 32207 2017-12-12
1295247948 Emed Urgent and Primary Care Pa Clinic/Center 2570 Atlantic Boulevard, Jacksonville, FL 32207 2017-11-02
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Taxonomy Information

Taxonomy Code 261QX0203X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Oncology, Radiation

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1093035628 Onslow Radiation Oncology LLC Clinic/Center 317 Western Blvd, Jacksonville, NC 28546-6338 2010-06-05

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1366875387 Cancer Center of Melbourne LLC Clinic/Center 415 S. Wickham Rd., Melbourne, FL 32904 2013-08-13
1326201591 St Pete Cancer Treatment Center LLC Clinic/Center 6449 38th Avenue, Suite C3-d3, North St Petersburg, FL 33710 2008-07-08
1407016678 Tampa Bay Radiosurgery Management Hillsborough LLC Clinic/Center 5935 Webb Rd, Tampa, FL 33615-3219 2008-06-11
1285784389 Mid-florida Radiation Oncology Pa Clinic/Center 1780 Se Hillmoor Dr, Port St Lucie, FL 34952-7558 2007-01-11
1720159247 Pedro A Serrano-ojeda Clinic/Center 3125 Nw 84th Ave, Doral, FL 33122-1994 2006-11-13
1740201912 North Florida Radiation Oncology LLC Clinic/Center 6420 Newberry Road, Gainesville, FL 32605 2006-07-22
1609896083 Mid-florida Radiation Oncology Pa Clinic/Center 301 Ne 19th Dr, Okeechobee, FL 34972-1911 2006-07-20
1700860681 Epirad Inc. Clinic/Center 400 Se Osceola St, Ste. 2, Stuart, FL 34994-2504 2005-12-03
1144211988 Mid Florida Radiation Oncology Asso Clinic/Center 604 W Midway Rd, Fort Pierce, FL 34982-4201 2005-11-01
1659834174 Sarasota Memorial Hospital Clinic/Center 5370 University Pkwy, Sarasota, FL 34243-5800 2019-04-11
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Competitor

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City JACKSONVILLE
Zip Code 32207

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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