CLINICAL PET OF LAKE CITY (NPI# 1972596450) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972596450 |
| Entity Type | Organization |
| Organization Name | CLINICAL PET OF LAKE CITY |
| Practice Address |
484 Sw Commerce Dr Suite 145 Lake City FL 32025-1507 |
| Mailing Address |
Po Box 773029 Ocala FL 34477-3029 |
| Practice Telephone | 3867543092 |
| Practice Fax Number | 3867546176 |
| Mailing Telephone | 3527950847 |
| Mailing Fax Number | 3527957843 |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2008-06-09 |
| Authorized Official Name | MR. GARESH D ARORA (PRESIDENT) |
| Authorized Official Telephone | 3524946142 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0200X |
Clinic/Center Specialization: Radiology |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS | V2683 | 01 |
| Street Address |
484 SW COMMERCE DR SUITE 145 |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32025-1507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437627015 | Gainesville Vamc | Clinic/Center | 484 Sw Commerce Dr, Lake City, FL 32025-1507 | 2018-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801438353 | Jennifer Bennett | Pharmacist | 347 Sw Main Blvd Suite 102, Lake City, FL 32025 | 2019-10-16 |
| 1700352838 | Robert J Sansouci IIi IIi | Physical Therapy Assistant | 560 Sw Mcfarlane Ave, Lake City, Fl, 32025, Lake City, FL 32025 | 2018-10-16 |
| 1316442783 | Emily Bailey | Developmental Therapist | 2126 Sw Sisters Welcome Rd, Lake City, FL 32025 | 2018-03-28 |
| 1811446370 | Michelle Hart | Behavioral Analyst | 260 S. Marion Avenue, Bldg. A, Suite 135, Lake City, FL 32025 | 2016-09-26 |
| 1922467646 | Irene Aponte Moreno | Nurse Practitioner | 440 Sw Perimeter Glen, Lake City, FL 32025 | 2016-02-23 |
| 1093186777 | Decarlos Scippio | Counselor | 619 Sw Baya Drive Suite 102, Lake City, FL 32025 | 2015-10-07 |
| 1497132476 | Jamecia Legree | Registered Nurse | 800 Sw Symphony Loop, Bldg 15 Apt 204, Lake City, FL 32025 | 2015-04-29 |
| 1306249149 | Mercy Home Assisted Living Facility LLC | Assisted Living Facility | 184 S.e. Beech Street, Lake City, FL 32025 | 2014-10-08 |
| 1598174344 | Karen Mcdonald | Developmental Therapist | 4523 Se County Road 252, Lake City, FL 32025 | 2014-08-06 |
| 1275944126 | Mohammad Ali Faisal Mdpa | Specialist | 1283 Sw State Rd 47, Ste 104, Lake City, FL 32025 | 2014-05-14 |
| Find all providers in zip 32025 | ||||
| Taxonomy Code | 261QR0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588855027 | Physicians Imaging -- Lake City LLC | Clinic/Center | 404 Nw Hall of Fame Dr, Lake City, FL 32055-4833 | 2007-08-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467053223 | Sheridan-pines Mri, LLC | Clinic/Center | 19442 Sheridan Street, Pembroke Pines, FL 33332 | 2020-11-06 |
| 1114535762 | Coral Hills Imaging LLC | Clinic/Center | 9690 W Sample Rd Ste 103, Coral Springs, FL 33065-4031 | 2020-07-20 |
| 1659990364 | Provectus Health LLC | Clinic/Center | 3972 Durksly Dr, Melbourne, FL 32940-1286 | 2020-04-13 |
| 1619500881 | Adventhealth West Florida Imaging, Inc. | Clinic/Center | 305 E Brandon Blvd Ste B, Brandon, FL 33511-5222 | 2020-02-17 |
| 1831736768 | Bria Group Inc | Clinic/Center | 880 Nw 13th St Ste 100, Boca Raton, FL 33486-2342 | 2019-12-10 |
| 1235770686 | Clermont Radiology LLC | Clinic/Center | 18 Ne 1st Ave, Ocala, FL 34470-6658 | 2019-10-07 |
| 1609422146 | Dis of Tampa Bay Inc | Clinic/Center | 3635 W Waters Ave, Tampa, FL 33614-2783 | 2019-08-12 |
| 1245891209 | Ohri, LLC | Clinic/Center | 392 Rinehart Rd., Suite 1300, Lake Mary, FL 32746 | 2019-06-21 |
| 1417518481 | Ohri, LLC | Clinic/Center | 5151 Winter Garden Vineland Road., Suite 104, Windermere, FL 34786 | 2019-06-21 |
| 1093273971 | Alfa Diagnostic LLC | Clinic/Center | 21355 E Dixie Hwy Ste 107, Aventura, FL 33180-1239 | 2019-03-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.