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Organization
NATIONAL PET SCAN DUVAL, LLC
Active
Organization
NATIONAL PET SCAN DUVAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANA LYNN WILSON (PROJECT MANAGER)
(904) 358-8441
Entity
Organization
Contact information
Practice address
425 N LEE ST, JACKSONVILLE, FL 32204-1127
(904) 861-6000
(904) 861-6007
Mailing address
1 INDEPENDENT DR, STE 2201, JACKSONVILLE, FL 32202-5015
(904) 358-8441
(904) 358-2288
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCC5690
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730079-001
CIGNA
FL
01
—
201709
WELLCARE
FL
01
—
3190985
AETNA HMO
FL
01
—
593688943
HUMANA
FL
01
—
7051350
AETNA NON HMO
FL
01
—
V2569
BLUE CROSS BLUE SHIELD FL
FL
Enumeration date
05/24/2005
Last updated
02/27/2012
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