Provider Demographics
NPI:1851384325
Name:CLINICAL PET OF CITRUS LLC
Entity Type:Organization
Organization Name:CLINICAL PET OF CITRUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GANESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:ARORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-494-6142
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:352-795-0847
Mailing Address - Fax:352-795-7843
Practice Address - Street 1:6140 W CORPORATE OAKS DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-8722
Practice Address - Country:US
Practice Address - Phone:352-795-0847
Practice Address - Fax:352-795-7843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2639OtherBCBS
FLU0121Medicare ID - Type Unspecified