Provider Demographics
NPI:1679648372
Name:NATIONAL PET SCAN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:NATIONAL PET SCAN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:UZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-535-8125
Mailing Address - Street 1:7867 N KENDALL DR STE 121
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7735
Mailing Address - Country:US
Mailing Address - Phone:305-455-3000
Mailing Address - Fax:305-455-2065
Practice Address - Street 1:7867 N KENDALL DR STE 121
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7735
Practice Address - Country:US
Practice Address - Phone:305-455-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN