Healthcare Provider Details

I. General information

NPI: 1427253707
Provider Name (Legal Business Name): CLINICAL PET OF OCALA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11950 COUNTY ROAD 101
THE VILLAGES FL
32162-9332
US

IV. Provider business mailing address

PO BOX 773029
OCALA FL
34477-3029
US

V. Phone/Fax

Practice location:
  • Phone: 352-391-6190
  • Fax: 352-391-6199
Mailing address:
  • Phone: 352-391-6190
  • Fax: 352-391-6199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberHCC7959
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GANESH ARORA
Title or Position: PRESIDENT
Credential: PHD
Phone: 352-291-0014