Healthcare Provider Details

I. General information

NPI: 1730009614
Provider Name (Legal Business Name): THE MEDICAL IMAGING PARTNERSHIP-JAX1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14043 N MAIN ST STE 109
JACKSONVILLE FL
32218-1707
US

IV. Provider business mailing address

1540 BUSINESS CENTER DR STE B
FLEMING ISLAND FL
32003-4419
US

V. Phone/Fax

Practice location:
  • Phone: 904-996-8100
  • Fax: 904-996-8101
Mailing address:
  • Phone: 330-495-1128
  • Fax: 904-389-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BETH NIEWIADOMSKI
Title or Position: DIR., REVENUE CYCLE
Credential:
Phone: 330-495-1128