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General NPI Number Information
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NPI Number | 1568459055
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE BEACHES MEDICAL IMAGING INC
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 6138 KENNERLY RD SUITE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4345
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Country | US
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Telephone | 904-733-7770
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Fax | 904-733-7778
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Provider Business Mailing Address
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Address Line | 6138 KENNERLY RD SUITE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4345
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Country | US
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Telephone | 904-733-7770
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Fax | 904-733-7778
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MRS. CATHY BLAESE
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Credential |
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Telephone | 904-241-7772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | HCCR1418
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License Number State | FL
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