Provider Demographics
NPI:1811051675
Name:PET CT OF MOBILE LLC
Entity type:Organization
Organization Name:PET CT OF MOBILE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ROWEN
Authorized Official - Last Name:ZURFLUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-633-0573
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0687
Mailing Address - Country:US
Mailing Address - Phone:251-316-3868
Mailing Address - Fax:261-316-3583
Practice Address - Street 1:100 MEMORIAL HOSPITAL DR
Practice Address - Street 2:SUITE 1E
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-316-3868
Practice Address - Fax:251-316-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00450207OtherRR MEDICARE
AL051558529Medicare PIN