Provider Demographics
NPI:1760602510
Name:TRI COUNTY PET LLC
Entity Type:Organization
Organization Name:TRI COUNTY PET LLC
Other - Org Name:PET IMAGING INSTITUTE OF SOUTH FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ-DENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-450-2202
Mailing Address - Street 1:603 N FLAMINGO RD
Mailing Address - Street 2:155
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1023
Mailing Address - Country:US
Mailing Address - Phone:954-450-2202
Mailing Address - Fax:954-450-8401
Practice Address - Street 1:603 N FLAMINGO RD
Practice Address - Street 2:155
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1023
Practice Address - Country:US
Practice Address - Phone:954-450-2202
Practice Address - Fax:954-450-8401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI COUNTY PET LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-26
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5508261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3783BMedicare PIN