Provider Demographics
NPI:1700842671
Name:CLINICAL PET OF ZEPHYRHILLS LLC
Entity Type:Organization
Organization Name:CLINICAL PET OF ZEPHYRHILLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GANESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:ARORA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-494-6142
Mailing Address - Street 1:PO BOX 773029
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-3029
Mailing Address - Country:US
Mailing Address - Phone:352-387-0275
Mailing Address - Fax:352-387-0277
Practice Address - Street 1:38044 DAUGHTERY RD
Practice Address - Street 2:100
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1375
Practice Address - Country:US
Practice Address - Phone:813-782-6824
Practice Address - Fax:813-788-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7179BMedicare ID - Type Unspecified