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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QX0203X |
Clinic/Center Specialization: Oncology, Radiation |
APPLYING | FL | Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
FL | 277325200 | 05 | |
FL | BCBS OF FL | 00389 | 01 |
FL | RR MEDICARE | DG1361 | 01 |
Other Name | Type Code |
---|---|
Memorial Cancer Center | Doing Business As Name - Organization |
Street Address |
5742 BOOTH RD SUITE B |
City | JACKSONVILLE |
State | FL |
Zip Code | 32207 |
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 |
Find all providers in the same location |
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 |
Find all providers in zip 32207 |
Taxonomy Code | 261QX0203X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Oncology, Radiation |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1093035628 | Onslow Radiation Oncology LLC | Clinic/Center | 317 Western Blvd, Jacksonville, NC 28546-6338 | 2010-06-05 |
NPI | Name | Taxonomy | Address | Enumeration |
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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 |
Find all providers with the same taxonomy |
City | JACKSONVILLE |
Zip Code | 32207 |
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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.