MEDICARE: NATIONAL P E T SCAN BROWARD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center	HCC5688	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	CK2451	OTHER	FL	MEDICARE RAILROAD RETIREM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	196704	OTHER	FL	WELLCARE
2	2630670	OTHER	FL	AETNA - HMO
3	593688943	OTHER	FL	TRICARE
5	38830	OTHER	FL	NEIGHBORHOOD
6	67826	OTHER	FL	FOUNDATION
7	V2274	OTHER	FL	BLUE CROSS BLUE SHIELD FL
8	593688943	OTHER	FL	HUMANA
9	SG011169	OTHER	FL	VISTA
10	6958176-001	OTHER	FL	CIGNA
11	7441285	OTHER	FL	AETNA - PPO
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194728014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL P E T SCAN BROWARD LLC

Provider Business Mailing Address
First Line	:	6622 SOUTHPOINT DR S
Second Line	:	SUITE 360
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8014
Country	:	US
Telephone Number	:	904-358-8441
Fax Number	:	904-358-2288

Provider Business Practice Location Address
First Line	:	6290 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-1917
Country	:	US
Telephone Number	:	954-332-3000
Fax Number	:	954-332-2671

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	MS. MARGIE FAYE AUSTIN
Credential	:
Telephone Number	:	904-358-8441

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/05/2012

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Directions to “NATIONAL P E T SCAN BROWARD LLC ” Practice Location

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