Provider Demographics
NPI:1891937876
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:MR
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:352-291-0014
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:352-291-0014
Mailing Address - Fax:352-291-0057
Practice Address - Street 1:7494 SW 60TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6428
Practice Address - Country:US
Practice Address - Phone:352-291-9484
Practice Address - Fax:352-291-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC84892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FLPENDINGMedicare PIN