Provider Demographics
NPI:1891798732
Name:NATIONAL P.E.T. SCAN DADE, LLC
Entity Type:Organization
Organization Name:NATIONAL P.E.T. SCAN DADE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:MS
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:305-455-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5689261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2845084-001OtherCIGNA
FL196701OtherWELLCARE
FL593688943OtherTRICARE
FL593688943OtherALL FLORIDA PPO
FL593688943OtherEVOLUTIONS
FLV2273OtherBLUE CROSS BLUE SHIELD FL
FL38829OtherNEIGHBORHOOD HEALTH
FL593688943OtherHUMANA
FLCK2452OtherMEDICARE RAILROAD RETIREM
FLSG011169OtherVISTA HEALTH
FLV2273OtherHEALTH OPTIONS
FL67830OtherFOUNDATION HEALTH
FLSG011169OtherVISTA HEALTH