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NPI Code Detail

MEDICARE: ST JOHNS IMAGING LLC

MEDICARE: ST JOHNS IMAGING LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician

General Provider Information

NPI Number : 1932398419
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST JOHNS IMAGING LLC
Provider Business Mailing Address
First Line : 840 CRESCENT CENTRE DR
Second Line : SUITE 200
City : FRANKLIN
State : TN
Zip : 37067-4626
Country : US
Telephone Number : 615-550-6009
Fax Number : 615-550-6004
Provider Business Practice Location Address
First Line : 2151 RIVERSIDE AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-4416
Country : US
Telephone Number : 615-550-6009
Fax Number : 615-550-6004
Authorized Official
Title or Position : CHIEF MANAGER
Name : MR. FRANK R KYLE
Credential :
Telephone Number : 615-550-6009
Provider Enumeration Date : 10/19/2007
Last Update Date : 03/31/2008

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Directions to “ST JOHNS IMAGING LLC ” Practice Location

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