Provider Demographics
NPI:1215008941
Name:WEST FLORIDA PET SERVICES LLC
Entity Type:Organization
Organization Name:WEST FLORIDA PET SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:LAVELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-344-8203
Mailing Address - Street 1:510 VONDERBURG DR
Mailing Address - Street 2:SUITE 3009
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5980
Mailing Address - Country:US
Mailing Address - Phone:813-657-4914
Mailing Address - Fax:813-657-4916
Practice Address - Street 1:510 VONDERBURG DR
Practice Address - Street 2:SUITE 3009
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5980
Practice Address - Country:US
Practice Address - Phone:813-657-4914
Practice Address - Fax:813-657-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MobileGroup - Single Specialty