21ST CENTURY ONCOLOGY LLC (NPI# 1306234174) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306234174 |
| Entity Type | Organization |
| Organization Name | 21ST CENTURY ONCOLOGY LLC |
| Other Organization Name | ANTHONY N AVALLONE MD |
| Practice Address |
914b Mar Walt Dr Fort Walton Beach FL 32547-6706 |
| Mailing Address |
2234 Colonial Blvd Fort Myers FL 33907-1412 |
| Practice Telephone | 8502266572 |
| Practice Fax Number | 8508628564 |
| Mailing Telephone | 2399317342 |
| Mailing Fax Number | 2399317385 |
| Enumeration Date | 2015-01-02 |
| Last Update Date | 2019-07-12 |
| Authorized Official Name | KIM COMMINS (CEO) |
| Authorized Official Telephone | 2399317277 |
| Is Organization Subpart | Y |
| Parent Organization Name | 21ST CENTURY ONCOLOGY INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Anthony N Avallone MD | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740748706 | 21st Century Oncology LLC | Internal Medicine | 3651 Fau Blvd Ste 100, Boca Raton, FL 33431-6489 | 2019-03-08 |
| 1669701918 | 21st Century Oncology LLC | Urology | 1044 Goodlette Rd N, Naples, FL 34102-5449 | 2009-12-16 |
| 1790993632 | 21st Century Oncology LLC | Durable Medical Equipment & Medical Supplies | 1255 Viscaya Pkwy # 2, Suite 201, Cape Coral, FL 33990-3290 | 2007-05-21 |
| 1316426281 | 21st Century Oncology LLC | Durable Medical Equipment & Medical Supplies | 1200 E Broward Blvd, Fort Lauderdale, FL 33301-2134 | 2018-08-10 |
| 1922456722 | 21st Century Oncology LLC | Surgery | 10141 Forest Hill Blvd, Wellington, FL 33414-6103 | 2016-06-02 |
| 1568820363 | 21st Century Oncology LLC | Surgery | 3300 Us 27 S, Avon Park, FL 33825-9701 | 2016-02-08 |
| 1558729855 | 21st Century Oncology LLC | Surgery | 6405 N Federal Hwy, Suite 401, Fort Lauderdale, FL 33308-1412 | 2016-02-02 |
| 1730551227 | 21st Century Oncology LLC | Surgery | 1411 N Flagler Dr, Suite 7300, West Palm Beach, FL 33401-3404 | 2015-10-23 |
| 1679945158 | 21st Century Oncology LLC | Urology | 787 37th St, Suite E-200, Vero Beach, FL 32960-7305 | 2015-10-23 |
| 1871964916 | 21st Century Oncology LLC | Urology | 10115 Forest Hill Blvd, Suite 100, Wellington, FL 33414-3105 | 2015-10-15 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | 21ST CENTURY ONCOLOGY LLC | 3651 Fau Blvd Ste 100, Boca Raton, FL 33431-6489 |
| Street Address |
914B MAR WALT DR |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-6706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821043811 | Basil D. Fossum | Specialist | 914b Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2006-05-24 |
| 1235326026 | Basil D. Fossum, M.d.,f.a.c.s | Urology | 914b Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2007-09-26 |
| 1851331474 | John R Burns | Urology | 914b Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2006-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598975641 | Christopher L Allam | Urology | 341 Racetrack Rd Nw, Suite B, Fort Walton Beach, FL 32547-1552 | 2007-05-23 |
| 1205804432 | Okaloosa Walton Urology Pa | Urology | 1112 Hospital Rd, Unit A, Fort Walton Beach, FL 32547-6655 | 2006-03-14 |
| 1356317002 | Robert Lawrence Long | Urology | 909 Mar Walt Dr, Suite 1011, Fort Walton Beach, FL 32547-6635 | 2006-02-23 |
| 1427339399 | Genesiscare Usa of Florida LLC | Urology | 914 Mar Walt Dr, Suite B, Fort Walton Beach, FL 32547-6706 | 2011-09-06 |
| 1144519018 | Beibei Oelrich | Urology | 1032 Mar Walt Dr Unit 250, Fort Walton Beach, FL 32547 | 2011-03-31 |
| 1174768477 | Genesiscare Usa of Florida LLC | Urology | 909 Mar Walt Dr, Suite 1011, Fort Walton Beach, FL 32547-6635 | 2008-12-16 |
| 1235326026 | Basil D. Fossum, M.d.,f.a.c.s | Urology | 914b Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2007-09-26 |
| 1891729026 | Emerald Coast Urology | Urology | 909 Mar Walt Dr, Suite 1011, Fort Walton Beach, FL 32547-6635 | 2006-07-11 |
| 1851331474 | John R Burns | Urology | 914b Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2006-06-08 |
| 1013957240 | William F Stiles IIi | Urology | 1032 Mar Walt Drive, Suite 250, Fort Walton Beach, FL 32547 | 2006-06-07 |
| Find all providers in FORT WALTON BEACH | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
Please comment or provide details below to improve the information on 21ST CENTURY ONCOLOGY LLC.
| 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.