| Entity Name: | ORLANDO CANCER CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Inactive |
| Date Filed: | 27 Feb 1990 (35 years ago) |
| Document Number: | N36827 |
| FEI/EIN Number | 593005020 |
| Mail Address: | 1414 KUHL AVENUE, MP 2, ORLANDO, FL, 32806, US |
| Address: | 1414 Kuhl Ave., MP 2, ORLANDO, FL, 32806, US |
| ZIP code: | 32806 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578510582 | 2006-05-27 | 2013-10-02 | 1400 S ORANGE AVE, ORLANDO, FL, 328062134, US | 1400 S ORANGE AVE, ORLANDO, FL, 328062134, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 407-648-3800 |
| Fax | 4074255203 |
Authorized person
| Name | MARK ROH |
| Role | PRESIDENT/CEO |
| Phone | 4076483800 |
Taxonomy
| Taxonomy Code | 207RH0003X - Hematology & Oncology Physician |
| Is Primary | No |
| Taxonomy Code | 207RX0202X - Medical Oncology Physician |
| Is Primary | Yes |
| Taxonomy Code | 207VX0201X - Gynecologic Oncology Physician |
| Is Primary | No |
| Taxonomy Code | 2085R0001X - Radiation Oncology Physician |
| Is Primary | No |
| Taxonomy Code | 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
| Is Primary | No |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051326100 |
| State | FL |
| Issuer | BCBS OF FLORIDA |
| Number | 00235 |
| State | FL |
| Issuer | TRICARE |
| Number | 007 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Zika Ryan ESQ | Agent | 207 W. Gore St., Suite 201, Orlando, FL, 32806 |
| Name | Role | Address |
|---|---|---|
| HAKIM JAMAL M | Director | 1414 Kuhl Ave., MP 2, ORLANDO, FL, 32806 |
| SPONG BERNADETTE | Director | 1414 Kuhl Ave., MP 2, ORLANDO, FL, 32806 |
| DESAI SUNIL SMD | Director | 1414 Kuhl Ave., MP 2, ORLANDO, FL, 32806 |
| Name | Role | Address |
|---|---|---|
| TAYLOR MATTHEW | Auth | 1414 Kuhl Ave., MP 2, ORLANDO, FL, 32806 |
| MILLER JOHN E | Auth | 1414 Kuhl Ave., MP 2, ORLANDO, FL, 32806 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000075793 | ORLANDO HEALTH UF HEALTH CANCER CENTER PHYSICIAN GROUP | EXPIRED | 2017-07-14 | 2022-12-31 | No data | 1414 KUHL AVE., MP2, ORLANDO, FL, 32806 |
| G14000003675 | UF HEALTH CANCER CENTER ORLANDO HEALTH PHYSICIAN GROUP | EXPIRED | 2014-01-10 | 2019-12-31 | No data | 1414 KUHL AVE., MP2, ORLANDO, FL, 32806 |
| G14000003676 | UF HEALTH CANCER CENTER AT ORLANDO HEALTH PHYSICIAN GROUP | EXPIRED | 2014-01-10 | 2019-12-31 | No data | 1414 KUHL AVE., MP2, ORLANDO, FL, 32806 |
| G12000031714 | MD ANDERSON CANCER CENTER ORLANDO PHYSICIAN GROUP | EXPIRED | 2012-04-02 | 2017-12-31 | No data | 1414 KUHL AVE., MP 2, ORLANDO, FL, 32806 |
| G11000117258 | MD ANDERSON CANCER CENTER ORLANDO | EXPIRED | 2011-12-05 | 2016-12-31 | No data | 1414 KUHL AVE., MP 2, ORLANDO, FL, 32806 |
| G11000019617 | ORLANDO HEALTH NUCLEAR MEDICINE PHYSICIANS | EXPIRED | 2011-02-22 | 2016-12-31 | No data | 1400 S. ORANGE AVENUE, SUITE 113, ORLANDO, FL, 32806 |
| G11000019620 | ORLANDO HEALTH NUCLEAR MEDICINE PHYSICIANS SERVICES | EXPIRED | 2011-02-22 | 2016-12-31 | No data | 1400 S. ORANGE AVENUE, SUITE 113, ORLANDO, FL, 32806 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2023-04-19 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 2020-02-18 | No data | No data |
| RESTATED ARTICLES | 1997-03-31 | No data | No data |
| AMENDMENT | 1990-05-29 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
