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NPI Code Detail

MEDICARE: NATIONAL P.E.T. SCAN PINELLAS, LLC

MEDICARE: NATIONAL P.E.T. SCAN PINELLAS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0200XRadiology Clinic/CenterHCC5686FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1593688943OTHERFLTRICARE
27642379OTHERFLAETNA NON HMO
3593688943OTHERFLHUMANA
4V2570OTHERFLBLUE CROSS BLUE SHIELD FL
5202977OTHERFLWELLCARE
62918309OTHERFLAETNA HMO
73540719-001OTHERFLCIGNA
8MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639172505
Entity Type Code : Organization
Provider Name (Legal Business Name) : NATIONAL P.E.T. SCAN PINELLAS, LLC
Provider Business Mailing Address
First Line : 6622 SOUTHPOINT DR S
Second Line : SUITE 360
City : JACKSONVILLE
State : FL
Zip : 32216-8014
Country : US
Telephone Number : 904-358-8441
Fax Number : 904-358-2288
Provider Business Practice Location Address
First Line : 6600 66TH ST N
Second Line : STE B
City : PINELLAS PARK
State : FL
Zip : 33781-5040
Country : US
Telephone Number : 904-358-8441
Fax Number : 727-471-2197
Authorized Official
Title or Position : ADMINISTRATIVE ASSISTANT
Name : MS. MARGIE FAYE AUSTIN
Credential :
Telephone Number : 904-358-8441
Provider Enumeration Date : 05/24/2005
Last Update Date : 12/05/2012

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