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General NPI Number Information
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NPI Number | 1811923550
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Entity Type | Organization
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Legal Business Name | FIRST COAST IMAGING LLC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 4933 UNIVERSITY BLVD W
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5935
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Country | US
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Telephone | 904-733-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 4933 UNIVERSITY BLVD W
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5935
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Country | US
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Telephone | 904-733-7800
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JUAN C. LUIS-JORGE
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Credential | M.D.
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Telephone | 904-733-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0052228
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License Number State | FL
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