Organization
NATIONAL PET CENTERS LLC
Active
Other names
Great Lakes Medical Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID L GILLILAND (OWNER)
(336) 274-2844
Entity
Organization
Contact information
Practice address
19250 BAGLEY ROAD, SUITE 203, NATIONAL PET CENTERS LLC DBA GREAT LAKES MEDICAL IMAGIN, MIDDLEBURG HEIGHTS, OH 44130
(440) 234-3321
(440) 234-3323
Mailing address
5313 DONA ROAD, JULIAN, NC 27283
(336) 274-2844
(336) 274-2817
Taxonomy
Speciality
Code
Description
License number
State
2471N0900X
Nuclear Medicine Technology Radiologic Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093798720
RENDERING PROVIDER NUMBERS
—
01
—
1275583791
RENDERING PROVIDER NUMBER
—
01
—
192232
ANTHEM BLUE SHIELD
—
01
—
192322
ANTHEM BC/BS
—
05
—
2326478
—
OH
Enumeration date
07/04/2006
Last updated
01/13/2011
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