Provider Demographics
NPI:1194750315
Name:INTEGRATED COMMUNITY ONCOLOGY NETWORK
Entity type:Organization
Organization Name:INTEGRATED COMMUNITY ONCOLOGY NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PARYANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-346-3338
Mailing Address - Street 1:2500 STARLING ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4265
Mailing Address - Country:US
Mailing Address - Phone:912-466-5100
Mailing Address - Fax:912-466-5113
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:SUITE 107
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-466-5100
Practice Address - Fax:912-466-5113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADD1817OtherMEDICARE RAILROAD
GADD1990OtherMEDICARE RAILROAD
GADD1990OtherMEDICARE RAILROAD