Provider Demographics
NPI:1811422934
Name:CLINICAL PET OF OCALA LLC
Entity Type:Organization
Organization Name:CLINICAL PET OF OCALA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GANESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:ARORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-291-0014
Mailing Address - Street 1:PO BOX 140970
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614-0970
Mailing Address - Country:US
Mailing Address - Phone:352-291-0014
Mailing Address - Fax:352-291-0057
Practice Address - Street 1:11740 SW 97TH TER
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-5273
Practice Address - Country:US
Practice Address - Phone:352-291-0014
Practice Address - Fax:352-291-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ518Medicare PIN