Organization
INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC
Active
Other names
McIver Urological Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J PHELAN (EXECUTIVE DIRECTOR)
(904) 363-2113
Entity
Organization
Contact information
Practice address
710 LOMAX ST, JACKSONVILLE, FL 32204-4004
(904) 355-6583
(904) 355-4922
Mailing address
9143 PHILIPS HWY, SUITE 560, JACKSONVILLE, FL 32256-1348
(904) 363-7453
(904) 538-3672
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC6938
RAILROAD MEDICARE
FL
Enumeration date
02/20/2008
Last updated
03/19/2009
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