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Organization

PINNACLE RADIOLOGY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KENNETH S HAZLETT M.D. (MANAGING MEMBER)
(321) 799-9172
Entity
Organization

Contact information

Practice address
490 N WASHINGTON AVE, TITUSVILLE, FL 32796-2871
(321) 268-4200
Mailing address
PO BOX 881839, PORT ST LUCIE, FL 34988-1839
(727) 896-3134
(770) 666-9330

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AM098
MEDICARE PTAN
FL
Enumeration date
03/05/2008
Last updated
02/23/2011
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