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Organization
NATIONAL P E T SCAN BROWARD LLC
Active
Organization
NATIONAL P E T SCAN BROWARD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARGIE FAYE AUSTIN (ADMINISTRATIVE ASSISTANT)
(904) 358-8441
Entity
Organization
Contact information
Practice address
6290 N FEDERAL HWY, FT LAUDERDALE, FL 33308-1917
(954) 332-3000
(954) 332-2671
Mailing address
6622 SOUTHPOINT DR S, SUITE 360, JACKSONVILLE, FL 32216-8014
(904) 358-8441
(904) 358-2288
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCC5688
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196704
WELLCARE
FL
01
—
2630670
AETNA - HMO
FL
01
—
38830
NEIGHBORHOOD
FL
01
—
593688943
TRICARE
FL
01
—
67826
FOUNDATION
FL
01
—
6958176-001
CIGNA
FL
01
—
7441285
AETNA - PPO
FL
01
—
CK2451
MEDICARE RAILROAD RETIREM
FL
01
—
SG011169
VISTA
FL
01
—
V2274
BLUE CROSS BLUE SHIELD FL
FL
Enumeration date
05/24/2005
Last updated
12/05/2012
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