Provider Demographics
NPI:1972596450
Name:CLINICAL PET OF LAKE CITY
Entity Type:Organization
Organization Name:CLINICAL PET OF LAKE CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARESH
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 1:484 SW COMMERCE DR
Practice Address - Street 2:SUITE 145
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1507
Practice Address - Country:US
Practice Address - Phone:386-754-3092
Practice Address - Fax:386-754-6176
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
FLV2683OtherBCBS
FLV2683OtherBCBS