Provider Demographics
NPI:1164452405
Name:NATIONAL P E T SCAN PALM BEACH LLC
Entity Type:Organization
Organization Name:NATIONAL P E T SCAN PALM BEACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRISBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-358-8441
Mailing Address - Street 1:1 INDEPENDENT DR
Mailing Address - Street 2:SUITE 2201
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-5039
Mailing Address - Country:US
Mailing Address - Phone:904-358-8441
Mailing Address - Fax:904-358-2288
Practice Address - Street 1:16110 JOG RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2350
Practice Address - Country:US
Practice Address - Phone:561-819-6711
Practice Address - Fax:561-819-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3381-2261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology