Provider Demographics
NPI:1225486848
Name:P,E,T. CT & MRI OF MIAMI, LLC
Entity Type:Organization
Organization Name:P,E,T. CT & MRI OF MIAMI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-458-0211
Mailing Address - Street 1:12905 SW 42ND ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2905
Mailing Address - Country:US
Mailing Address - Phone:305-229-2020
Mailing Address - Fax:305-229-2218
Practice Address - Street 1:12905 SW 42ND ST
Practice Address - Street 2:SUITE 106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2905
Practice Address - Country:US
Practice Address - Phone:305-229-2020
Practice Address - Fax:305-229-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8124261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003567600Medicaid
FL003567600Medicaid