Provider Demographics
NPI:1740221167
Name:PET IMAGING RADIOLOGY PSC
Entity type:Organization
Organization Name:PET IMAGING RADIOLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-269-2442
Mailing Address - Street 1:PO BOX 1186
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1186
Mailing Address - Country:US
Mailing Address - Phone:787-269-2442
Mailing Address - Fax:787-780-0143
Practice Address - Street 1:100 PASEO SAN PABLO
Practice Address - Street 2:SUITE 208 EDIFICIO DR. ARTURO CADILLA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7019
Practice Address - Country:US
Practice Address - Phone:787-269-2442
Practice Address - Fax:787-780-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPR2006-042085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085142Medicare PIN