Healthcare Provider Details

I. General information

NPI: 1801718168
Provider Name (Legal Business Name): JACKSONVILLE IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 GATE PKWY STE 111
JACKSONVILLE FL
32256-3104
US

IV. Provider business mailing address

7540 GATE PKWY STE 111
JACKSONVILLE FL
32256-3104
US

V. Phone/Fax

Practice location:
  • Phone: 305-273-4641
  • Fax: 305-631-7680
Mailing address:
  • Phone: 324-587-6499
  • Fax: 324-587-6497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MONICA MUNIZ
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 305-273-4641