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Organization
JACKSONVILLE BEACHES MEDICAL IMAGING INC
Active
Organization
JACKSONVILLE BEACHES MEDICAL IMAGING INC
Active
Other names
SOUTHSIDE 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
6138 KENNERLY RD, SUITE 101, JACKSONVILLE, FL 32216-4345
(904) 733-7770
(904) 733-7778
Mailing address
6138 KENNERLY RD, SUITE 101, JACKSONVILLE, FL 32216-4345
(904) 733-7770
(904) 733-7778
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCCR1418
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147878601
1ST HEALTH W/C #
FL
01
—
1840590
1ST HEALTH PROVIDER
FL
01
—
2052827
UNITED HEALTH CARE
FL
01
—
470001168
RR MEDICARE PIN
FL
01
—
7842141
AETNA PROVIDER #
FL
01
—
V2499
BCBS VIN #
FL
Enumeration date
09/30/2005
Last updated
10/02/2012
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