Organization
PET LLC
Active
Organization
PET LLC
Active
Other names
The PET/CT Imaging Center of Northwest Florida
Organization subpart
No
Provider details
NPI number
Authorized official
CLARK M. POLLITT MD (MANAGING PARTNER)
(850) 478-6336
Entity
Organization
Contact information
Practice address
5149 N 9TH AVE, STE 124, PENSACOLA, FL 32504-8756
(850) 478-6336
(850) 478-6361
Mailing address
5149 N 9TH AVE STE 124, PENSACOLA, FL 32504-8779
(850) 478-6336
(850) 478-6361
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
Primary
3670 1
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G0905
WELLCARE
FL
01
—
P00274147
RR MEDICARE
FL
01
—
V2974
BCBS OF FLORIDA
FL
Enumeration date
08/05/2006
Last updated
03/09/2020
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