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General NPI Number Information
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NPI Number | 1639172505
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Entity Type | Organization
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Legal Business Name | NATIONAL P.E.T. SCAN PINELLAS, LLC
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 6600 66TH ST N STE B
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City | PINELLAS PARK
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State | FL
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Zip | 33781-5040
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Country | US
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Telephone | 904-358-8441
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Fax | 727-471-2197
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Provider Business Mailing Address
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Address Line | 6622 SOUTHPOINT DR S SUITE 360
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8014
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Country | US
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Telephone | 904-358-8441
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Fax | 904-358-2288
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MS. MARGIE FAYE AUSTIN
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Credential |
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Telephone | 904-358-8441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | HCC5686
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License Number State | FL
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