Organization
NATIONAL P.E.T. SCAN PINELLAS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARGIE FAYE AUSTIN (ADMINISTRATIVE ASSISTANT)
(904) 358-8441
Entity
Organization
Contact information
Practice address
6600 66TH ST N, STE B, PINELLAS PARK, FL 33781-5040
(904) 358-8441
(727) 471-2197
Mailing address
6622 SOUTHPOINT DR S, SUITE 360, JACKSONVILLE, FL 32216-8014
(904) 358-8441
(904) 358-2288
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCC5686
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202977
WELLCARE
FL
01
—
2918309
AETNA HMO
FL
01
—
3540719-001
CIGNA
FL
01
—
593688943
TRICARE
FL
01
—
7642379
AETNA NON HMO
FL
01
—
V2570
BLUE CROSS BLUE SHIELD FL
FL
Enumeration date
05/24/2005
Last updated
12/05/2012
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