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Organization
JACKSONVILLE BEACHES MEDICAL IMAGING INC
Active
Organization
JACKSONVILLE BEACHES MEDICAL IMAGING INC
Active
Other names
JACKSONVILLE MEDICAL IMAGING
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CATHY BLAESE (CHIEF OPERATING OFFICER)
(904) 241-7772
Entity
Organization
Contact information
Practice address
2700 RIVERSIDE AVE, SUITE 1, JACKSONVILLE, FL 32205-8275
(904) 381-9994
(904) 389-6866
Mailing address
2700 RIVERSIDE AVE, SUITE 1, JACKSONVILLE, FL 32205-8275
(904) 381-9994
(904) 389-6866
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCCR1430
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147878902
1ST HEALTH W/C #
FL
01
—
1840590
1ST HEALTH PROVIDER #
FL
01
—
2000441
UNITED HEALTH CARE
FL
01
—
470001666
RR MEDICARE PROVIDER #
FL
01
—
7842141
AETNA PROVIDER #
FL
01
—
V2622
BCBS FL PIN #
FL
Enumeration date
09/30/2005
Last updated
10/02/2012
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