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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