Organization
FIRST COAST IMAGING, LLC
Active
Other names
Select Diagnostics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUAN C. LUIS-JORGE M.D. (MEDICAL DIRECTOR)
(904) 733-7800
Entity
Organization
Contact information
Practice address
159 N 3RD ST, MACCLENNY, FL 32063-2103
(904) 733-7800
(904) 419-4888
Mailing address
159 N 3RD ST, MACCLENNY, FL 32063-2103
(904) 653-4645
(904) 653-4637
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME0052228
FL
Other
Enumeration date
05/04/2007
Last updated
08/22/2020
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