Organization
TREASURE COAST CANCER CARE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIVA P BELLAM M.D (PRESIDENT)
(772) 398-6016
Entity
Organization
Contact information
Practice address
1700 SE HILLMOOR DR, STE 306, PORT ST LUCIE, FL 34952-7539
(772) 398-6016
(772) 337-0320
Mailing address
1700 SE HILLMOOR DR, STE 306, PORT ST LUCIE, FL 34952-7539
(772) 398-6016
(772) 337-0320
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
ME0070221
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
235170784
TRICARE
FL
05
—
250467700
—
FL
01
—
2967902005
CIGNA
FL
01
—
31481
BLUECROSS BLUESHIELD
FL
01
—
830005561
RAIL ROAD MEDICARE
FL
Enumeration date
09/13/2005
Last updated
06/26/2014
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