Healthcare Provider Details

I. General information

NPI: 1942293410
Provider Name (Legal Business Name): CLINICAL PET OF HERNANDO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 MARINE BLVD
SPRINGHILL FL
34609-2466
US

IV. Provider business mailing address

PO BOX 773029
OCALA FL
34477-3029
US

V. Phone/Fax

Practice location:
  • Phone: 352-688-2505
  • Fax: 352-689-5405
Mailing address:
  • Phone: 352-795-0847
  • Fax: 352-795-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GANESH D ARORA
Title or Position: PRESIDENT
Credential:
Phone: 352-494-6142