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Organization
WEST FLORIDA PET SERVICES LLC
Active
Organization
WEST FLORIDA PET SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM B. RUTHERFORD (SENIOR VP)
(615) 309-2190
Entity
Organization
Contact information
Practice address
427 SOUTH PARSONS AVE, SUITE 101, BRANDON, FL 33511-5980
(813) 315-2080
(813) 315-2090
Mailing address
427 SOUTH PARSONS AVE, SUITE 101, BRANDON, FL 33511-5980
(813) 315-2080
(813) 315-2090
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
—
—
261QR0206X
Mammography Clinic/Center
—
—
261QR0207X
Mobile Mammography Clinic/Center
—
—
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V3345
BCBS OF FL
FL
Enumeration date
06/21/2005
Last updated
08/31/2011
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