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General NPI Number Information
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NPI Number | 1932398419
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Entity Type | Organization
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Legal Business Name | ST JOHNS IMAGING LLC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 2151 RIVERSIDE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4416
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Country | US
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Telephone | 615-550-6009
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Fax | 615-550-6004
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Provider Business Mailing Address
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Address Line | 840 CRESCENT CENTRE DR SUITE 200
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City | FRANKLIN
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State | TN
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Zip | 37067-4626
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Country | US
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Telephone | 615-550-6009
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Fax | 615-550-6004
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Authorized Official
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Title or Position | CHIEF MANAGER
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Name | MR. FRANK R KYLE
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Credential |
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Telephone | 615-550-6009
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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 |
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License Number State |
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