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Organization
JACKSONVILLE BEACHES MEDICAL IMAGING INC
Active
Organization
JACKSONVILLE BEACHES MEDICAL IMAGING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CATHY BLAESE (CHIEF OPERATING OFFICER)
(904) 241-7772
Entity
Organization
Contact information
Practice address
3316 3RD ST S, SUITE 101, JACKSONVILLE BEACH, FL 32250-6073
(904) 241-7772
(904) 241-7702
Mailing address
3316 3RD ST S, SUITE 101, JACKSONVILLE BEACH, FL 32250-6073
(904) 241-7772
(904) 241-7702
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCCR1416
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1416
HEALTH CARE CLINIC REG
FL
01
—
147878900
1ST HEALTH W/C ID
FL
01
—
1840590
FIRST HEALTH ID
FL
01
—
470001169
RR MEDICARE
FL
01
—
V2405
BCBS PROVIDER #
FL
Enumeration date
09/29/2005
Last updated
10/02/2012
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