Provider Demographics
NPI:1033194238
Name:PASADENA RADIOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:PASADENA RADIOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIT
Authorized Official - Middle Name:H
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:727-341-7552
Mailing Address - Street 1:PO BOX 14609
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-4609
Mailing Address - Country:US
Mailing Address - Phone:727-793-9300
Mailing Address - Fax:
Practice Address - Street 1:1501 PASADENA AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707
Practice Address - Country:US
Practice Address - Phone:727-381-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCF7473OtherRR MEDICARE
FL036532700Medicaid
FL00461OtherBCBS
FL00461Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER