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	261QR0200X	Radiology Clinic/Center		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V3014	OTHER	FL	BC/BS OCOEE, FL

General Provider Information

NPI Number	:	1477560514
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	:	33756-5945
Country	:	US
Telephone Number	:	727-446-6760
Fax Number	:	727-441-2465

Provider Business Practice Location Address
First Line	:	1193 BLACKWOOD AVE
Second Line	:	UNIT H
City	:	OCOEE
State	:	FL
Zip	:	34761-4518
Country	:	US
Telephone Number	:	407-656-6040
Fax Number	:	407-656-4431

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/27/2012

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Directions to “SRA VENTURES INC ” Practice Location

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