Basic Information
Provider Information | |||||||||
NPI: | 1679978118 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BAPTIST HEALTH MEDICAL GROUP ONCOLOGY LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
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Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
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OtherLastName: |   | ||||||||
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Mailing Information | |||||||||
Address1: | 6855 S RED RD STE 540 | ||||||||
Address2: |   | ||||||||
City: | SOUTH MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331433647 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7866627111 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 8900 N KENDALL DR | ||||||||
Address2: |   | ||||||||
City: | MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331762118 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7865962000 | ||||||||
FaxNumber: | 3052797778 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/27/2014 | ||||||||
LastUpdateDate: | 08/08/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ARSENAULT | ||||||||
AuthorizedOfficialFirstName: | MATTHEW | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 7866627111 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
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NPICertificationDate: | 08/08/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 332B00000X |   |   | N |   | Suppliers | Durable Medical Equipment & Medical Supplies |   | 2080P0207X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | 207RH0003X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.