Organization
SRA VENTURES, INC.
Active
Other names
WESTCOAST RADIOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY ABOUD D.O. (C.E.O.)
(407) 228-6635
Entity
Organization
Contact information
Practice address
572 OCOEE COMMERCE PARKWAY, OCOEE, FL 34761
(407) 228-6635
Mailing address
501 S LINCOLN AVE, 15, CLEARWATER, FL 33756-5945
(727) 446-6760
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E4187
MEDICARE PTAN
FL
Enumeration date
09/29/2009
Last updated
10/21/2009
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