MEDICARE: DAVIS DIAGNOSTICS 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
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	HCC1817-EXEMPT	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V2694	OTHER	FL	BCBS PROV #

General Provider Information

NPI Number	:	1992708580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIS DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	240 N WASHINGTON BLVD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-5945
Country	:	US
Telephone Number	:	941-925-3490
Fax Number	:	941-953-4452

Provider Business Practice Location Address
First Line	:	290 CLYDE MORRIS BLVD
Second Line	:	STE C1
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8204
Country	:	US
Telephone Number	:	386-677-8680
Fax Number	:	386-677-6895

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFF DAVIS
Credential	:
Telephone Number	:	386-677-8680

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/22/2020

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