Provider Demographics
NPI:1346318953
Name:PINELLAS RADIATION ASSOCIATES
Entity Type:Organization
Organization Name:PINELLAS RADIATION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRILL
Authorized Official - Middle Name:L
Authorized Official - Last Name:FETTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-343-0600
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33731-0148
Mailing Address - Country:US
Mailing Address - Phone:727-343-0600
Mailing Address - Fax:727-344-6163
Practice Address - Street 1:1201 5TH AVE N STE 120
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1410
Practice Address - Country:US
Practice Address - Phone:727-343-0600
Practice Address - Fax:727-344-6163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060217500 01Medicaid
FL=========AOtherHUMANA GROUP NUMBER
FL=========OtherUNIVERSAL PROVIDER NUMBER
FL=========OtherUNITED HEALTH CARE NUMBER
FL060217500 01Medicaid
FL=========OtherWELL CARE PROVIDER NUMBER
FL=========OtherAETNA GROUP NUMBER
FL=========OtherBLUE CROSS BLUE SHIELD
FL=========OtherUNITED HEALTH CARE NUMBER