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NPI Code Detail

MEDICARE: PINELLAS RADIATION ASSOCIATES

MEDICARE: PINELLAS RADIATION ASSOCIATES
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
12085R0001XRadiation Oncology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346318953
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINELLAS RADIATION ASSOCIATES
Provider Business Mailing Address
First Line : PO BOX 148
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33731-0148
Country : US
Telephone Number : 727-343-0600
Fax Number : 727-344-6163
Provider Business Practice Location Address
First Line : 1201 5TH AVE N STE 120
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33705-1410
Country : US
Telephone Number : 727-343-0600
Fax Number : 727-344-6163
Authorized Official
Title or Position : BUSINESS MANAGER
Name : MS. SHERRILL L FETTING
Credential :
Telephone Number : 727-343-0600
Provider Enumeration Date : 12/01/2006
Last Update Date : 08/22/2020

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Directions to “PINELLAS RADIATION ASSOCIATES ” Practice Location

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