Healthcare Provider Details

I. General information

NPI: 1205829934
Provider Name (Legal Business Name): SRA VENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S LINCOLN AVE #15
CLEARWATER FL
33756-5945
US

IV. Provider business mailing address

501 S LINCOLN AVE #15
CLEARWATER FL
33756-5901
US

V. Phone/Fax

Practice location:
  • Phone: 727-446-6760
  • Fax: 727-441-2465
Mailing address:
  • Phone: 727-446-6760
  • Fax: 727-441-2465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberHCC2621
License Number StateFL

VIII. Authorized Official

Name: DR. ANTHONY ABOUD
Title or Position: CEO
Credential: DO
Phone: 727-446-6760