Healthcare Provider Details

I. General information

NPI: 1700909900
Provider Name (Legal Business Name): RADIOLOGY CONSULTANTS OF JACKSONVILLE MRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7999 PHILIPS HWY STE 310
JACKSONVILLE FL
32256-4404
US

IV. Provider business mailing address

210 S FEDERAL HWY STE 403
HOLLYWOOD FL
33020-6811
US

V. Phone/Fax

Practice location:
  • Phone: 904-652-0614
  • Fax: 954-929-2001
Mailing address:
  • Phone: 954-929-3400
  • Fax: 954-929-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License NumberME20137
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberME20137
License Number StateFL

VIII. Authorized Official

Name: VLADIMIR GRNJA
Title or Position: PRESIDENT
Credential: MD
Phone: 954-929-3400