Healthcare Provider Details

I. General information

NPI: 1043233380
Provider Name (Legal Business Name): JACKSONVILLE MOBILE IMAGING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4237 SALISBURY RD SUITE 306
JACKSONVILLE FL
32216-8029
US

IV. Provider business mailing address

4237 SALISBURY RD SUITE 306
JACKSONVILLE FL
32216-8029
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-0353
  • Fax: 904-296-9403
Mailing address:
  • Phone: 904-296-0353
  • Fax: 904-296-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License NumberHCC3853
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License NumberHCC3853
License Number StateFL

VIII. Authorized Official

Name: MR. DAVID JOHNSON
Title or Position: PRESIDENT
Credential: RT.,NMT
Phone: 904-296-0353