Organization · NPI-2
21st Century Oncology LLC
Urology · Crestview, FL
NPI number1346561289
StatusActive
Last updated in NPPESFeb 3, 2025
Details
- NPI
- 1346561289
- Entity type
- Organization (NPI-2)
- Legal business name
- 21st Century Oncology LLC
- Organization subpart
- Yes
- Enumeration date
- Jun 15, 2010
- Certification date
- Feb 3, 2025
- Last updated
- Feb 3, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208800000X | Urology | – | – | Yes |
| 208D00000X | General Practice | – | – |
Other names
- Okaloosa-Walton Urology (Doing Business As)
Practice location
131 E Redstone AveSuite 102
Crestview, FL 32539-5326
Phone 850-682-6333 · Fax 850-682-0865
Mailing address
2234 Colonial BlvdFort Myers, FL 33907-1412
Phone 239-931-7342 · Fax 239-931-7385
Authorized official
Dianna Harrison
Sr. Director Of Provider Relations
2399317342
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