Healthcare Provider Details

I. General information

NPI: 1679648372
Provider Name (Legal Business Name): NATIONAL PET SCAN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7867 N KENDALL DR STE 121
MIAMI FL
33156-7735
US

IV. Provider business mailing address

7867 N KENDALL DR STE 121
MIAMI FL
33156-7735
US

V. Phone/Fax

Practice location:
  • Phone: 305-455-3000
  • Fax:
Mailing address:
  • Phone: 305-455-3000
  • Fax: 305-455-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANA LYNN UZZELL
Title or Position: PROJECT MANAGER
Credential:
Phone: 904-535-8125