Organization
WEST FLORIDA PET SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVELLE R HARDIN (ANALYST)
(615) 344-8203
Entity
Organization
Contact information
Practice address
510 VONDERBURG DR, SUITE 3009, BRANDON, FL 33511-5980
(813) 657-4914
(813) 657-4916
Mailing address
510 VONDERBURG DR, SUITE 3009, BRANDON, FL 33511-5980
(813) 657-4914
(813) 657-4916
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
261QR0207X
Mobile Mammography Clinic/Center
—
—
261QR0208X
Mobile Radiology Clinic/Center
—
—
Other
Enumeration date
11/13/2006
Last updated
12/03/2008
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