1760475230 NPI number — CLINICAL PET OF OCALA LLC

Table of content: (NPI 1760475230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760475230 NPI number — CLINICAL PET OF OCALA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL PET OF OCALA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760475230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 773029
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34477-3029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-291-0014
Provider Business Mailing Address Fax Number:
352-291-0057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3143 SW 32ND AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34474-4446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-291-0014
Provider Business Practice Location Address Fax Number:
352-291-0057
Provider Enumeration Date:
08/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ARORA
Authorized Official First Name:
GANESH
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-494-6142

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  HCC5511 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: V2532 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com