| Entity Name: | NATIONAL P.E.T. SCAN DADE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Sep 2000 (24 years ago) |
| Document Number: | L00000011312 |
| FEI/EIN Number | 593673859 |
| Address: | 7867 N. KENDALL DRIVE STE 121, MIAMI, FL, 33156, US |
| Mail Address: | 7867 Kendall Drive, Miami, FL, 33156, US |
| ZIP code: | 33156 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1891798732 | 2005-05-24 | 2023-01-11 | 7867 N KENDALL DR STE 121, MIAMI, FL, 331567735, US | 7867 N KENDALL DR STE 121, MIAMI, FL, 331567735, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-455-3000 |
| Fax | 3054552065 |
Authorized person
| Name | MS. DIANA LYNN UZZELL |
| Role | PROJECT MANAGER |
| Phone | 9045358125 |
Taxonomy
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| License Number | HCC5689 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CIGNA |
| Number | 2845084-001 |
| State | FL |
| Issuer | WELLCARE |
| Number | 196701 |
| State | FL |
| Issuer | TRICARE |
| Number | 593688943 |
| State | FL |
| Issuer | ALL FLORIDA PPO |
| Number | 593688943 |
| State | FL |
| Issuer | EVOLUTIONS |
| Number | 593688943 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD FL |
| Number | V2273 |
| State | FL |
| Issuer | NEIGHBORHOOD HEALTH |
| Number | 38829 |
| State | FL |
| Issuer | HUMANA |
| Number | 593688943 |
| State | FL |
| Issuer | MEDICARE RAILROAD RETIREM |
| Number | CK2452 |
| State | FL |
| Issuer | VISTA HEALTH |
| Number | SG011169 |
| State | FL |
| Issuer | HEALTH OPTIONS |
| Number | V2273 |
| State | FL |
| Issuer | FOUNDATION HEALTH |
| Number | 67830 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Rojas Maria R | Agent | NATIONAL PET SCAN DADE, LLC, MIAMI, FL, 33156 |
| Name | Role | Address |
|---|---|---|
| Rojas Maria R | Chief Executive Officer | 7867 N. KENDALL DRIVE STE 121, MIAMI, FL, 33156 |
| Name | Role |
|---|---|
| NATIONAL P.E.T. SCAN MANAGEMENT, LLC | Managing Member |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
