Healthcare Provider Details

I. General information

NPI: 1982686366
Provider Name (Legal Business Name): SOUTHERN CARDIAC NUCLEAR IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2005
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6484 FORT CAROLINE RD
JACKSONVILLE FL
32277-2042
US

IV. Provider business mailing address

PO BOX 144333
ORLANDO FL
32814-4333
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-5755
  • Fax: 866-887-9246
Mailing address:
  • Phone: 407-422-9831
  • Fax: 407-648-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: FLOYD W. BURKE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 352-332-8991