1891798732 NPI number — NATIONAL P.E.T. SCAN DADE, LLC

Table of content: (NPI 1891798732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891798732 NPI number — NATIONAL P.E.T. SCAN DADE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL P.E.T. SCAN DADE, 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:
1891798732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7867 N KENDALL DR STE 121
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33156-7735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-455-3000
Provider Business Mailing Address Fax Number:
305-455-2065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7867 N KENDALL DR STE 121
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33156-7735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-455-3000
Provider Business Practice Location Address Fax Number:
305-455-2065
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
UZZELL
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PROJECT MANAGER
Authorized Official Telephone Number:
904-535-8125

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  HCC5689 , 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: 2845084-001 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 196701 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 593688943 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 593688943 . This is a "ALL FLORIDA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 593688943 . This is a "EVOLUTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2273 . This is a "BLUE CROSS BLUE SHIELD FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 38829 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 593688943 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CK2452 . This is a "MEDICARE RAILROAD RETIREM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: SG011169 . This is a "VISTA HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2273 . This is a "HEALTH OPTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 67830 . This is a "FOUNDATION HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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