Provider Demographics
NPI:1932373792
Name:NATIONAL P E T SCAN PINELLAS LLC
Entity type:Organization
Organization Name:NATIONAL P E T SCAN PINELLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:UZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-358-8441
Mailing Address - Street 1:1 INDEPENDENT DR
Mailing Address - Street 2:SUITE 2201
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-5039
Mailing Address - Country:US
Mailing Address - Phone:904-358-8441
Mailing Address - Fax:904-358-2288
Practice Address - Street 1:6600 66TH ST
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5032
Practice Address - Country:US
Practice Address - Phone:727-471-1000
Practice Address - Fax:727-471-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology