Provider Demographics
NPI:1205891462
Name:PET FUSION CENTER, LLC
Entity type:Organization
Organization Name:PET FUSION CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-883-8995
Mailing Address - Street 1:4204 HOUMA BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2903
Mailing Address - Country:US
Mailing Address - Phone:504-883-8995
Mailing Address - Fax:504-883-8996
Practice Address - Street 1:4204 HOUMA BOULEVARD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2903
Practice Address - Country:US
Practice Address - Phone:504-883-8995
Practice Address - Fax:504-883-8996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0200X
LA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CB31Medicare ID - Type UnspecifiedLA GROUP MEDICARE NUMBER