Provider Demographics
NPI:1427071604
Name:AFFILIATED PET SYSTEMS LLC
Entity type:Organization
Organization Name:AFFILIATED PET SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-300-2777
Mailing Address - Street 1:8300 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 FOREST GLEN RD STE 430
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1464
Practice Address - Country:US
Practice Address - Phone:301-681-9100
Practice Address - Fax:301-681-9141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOLECULAR IMAGING TECHNOLOGIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-26
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD482003700Medicaid
F914OtherBCBS
F914OtherBCBS
MD482003700Medicaid