Healthcare Provider Details

I. General information

NPI: 1497910087
Provider Name (Legal Business Name): JACKSONVILLE ORTHOPAEDIC INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SAN MARCO BLVD SUITE 102
JACKSONVILLE FL
32207-8568
US

IV. Provider business mailing address

PO BOX 117345
ATLANTA GA
30368-7345
US

V. Phone/Fax

Practice location:
  • Phone: 904-858-7045
  • Fax: 904-858-7047
Mailing address:
  • Phone: 904-346-3465
  • Fax: 904-858-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: JOHN J RICCHINI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 904-346-3465