Organization
INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC
Active
Other names
Cancer Center of Palm Coast
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J PHELAN (EXECUTIVE DIRECTOR)
(904) 363-2113
Entity
Organization
Contact information
Practice address
9 PINE CONE DR, SUITE 108, PALM COAST, FL 32137-8686
(386) 445-7334
(386) 445-7389
Mailing address
9143 PHILIPS HWY, SUITE 560, JACKSONVILLE, FL 32256-1348
(904) 363-2113
(904) 538-3672
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273427324
—
FL
01
—
94890
BCBS
FL
Enumeration date
01/24/2007
Last updated
05/24/2012
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