Provider Demographics
NPI:1235148578
Name:PET LLC
Entity Type:Organization
Organization Name:PET LLC
Other - Org Name:THE PET/CT IMAGING CENTER OF NORTHWEST FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:POLLITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-478-6336
Mailing Address - Street 1:5149 N 9TH AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8779
Mailing Address - Country:US
Mailing Address - Phone:850-478-6336
Mailing Address - Fax:850-478-6361
Practice Address - Street 1:5149 N 9TH AVE
Practice Address - Street 2:STE 124
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8756
Practice Address - Country:US
Practice Address - Phone:850-478-6336
Practice Address - Fax:850-478-6361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3670 12085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00274147OtherRR MEDICARE
FLV2974OtherBCBS OF FLORIDA
FLG0905OtherWELLCARE
FLV2974OtherBCBS OF FLORIDA
FLG0905OtherWELLCARE