Provider Demographics
NPI:1659358984
Name:PANHANDLE PET IMAGING, LTD
Entity Type:Organization
Organization Name:PANHANDLE PET IMAGING, LTD
Other - Org Name:PANHANDLE PET IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-675-2600
Mailing Address - Street 1:PO BOX 292921
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33687-2921
Mailing Address - Country:US
Mailing Address - Phone:813-675-2498
Mailing Address - Fax:813-971-0818
Practice Address - Street 1:6700 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1729
Practice Address - Country:US
Practice Address - Phone:806-457-9700
Practice Address - Fax:806-457-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1558090Medicaid
TX1558090Medicaid