Healthcare Provider Details

I. General information

NPI: 1700130010
Provider Name (Legal Business Name): PRECISION IMAGING ST. AUGUSTINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PLANTATION ISLAND DR S SUITE 1
ST AUGUSTINE FL
32080-3100
US

IV. Provider business mailing address

PO BOX 96418
CHARLOTTE NC
28296-0418
US

V. Phone/Fax

Practice location:
  • Phone: 904-996-8100
  • Fax: 904-996-8101
Mailing address:
  • Phone: 904-996-8100
  • 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: JOSH HAMMOND
Title or Position: CEO
Credential:
Phone: 904-996-8100