MEDICARE: SRA VENTURES INC

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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
2	261QR0206X	Mammography Clinic/Center
3	261QR0200X	Radiology Clinic/Center	HCC2621	FL

General Provider Information

NPI Number	:	1205829934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SRA VENTURES INC

Provider Business Mailing Address
First Line	:	501 S LINCOLN AVE
Second Line	:	#15
City	:	CLEARWATER
State	:	FL
Zip	:	33756-5901
Country	:	US
Telephone Number	:	727-446-6760
Fax Number	:	727-441-2465

Provider Business Practice Location Address
First Line	:	501 S LINCOLN AVE
Second Line	:	#15
City	:	CLEARWATER
State	:	FL
Zip	:	33756-5945
Country	:	US
Telephone Number	:	727-446-6760
Fax Number	:	727-441-2465

Authorized Official
Title or Position	:	CEO
Name	:	DR. ANTHONY ABOUD
Credential	:	DO
Telephone Number	:	727-446-6760

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	04/05/2012

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Directions to “SRA VENTURES INC ” Practice Location

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