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General NPI Number Information
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NPI Number | 1164592218
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Entity Type | Organization
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Legal Business Name | MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLE
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1400 BISHOP ESTATES RD
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City | JACKSONVILLE
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State | FL
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Zip | 32259-4244
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Country | US
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Telephone | 904-287-6263
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Fax | 904-287-6213
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Provider Business Mailing Address
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Address Line | PO BOX 5606
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City | JACKSONVILLE
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State | FL
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Zip | 32247-5606
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Country | US
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Telephone | 904-287-6263
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Fax | 904-287-6213
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Authorized Official
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Title or Position | BUSINESS DIRECTOR
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Name | MR. NICOLAU SACAQUINI
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Credential |
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Telephone | 904-731-1556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | HCC5331
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License Number State | FL
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