Organization
IMAGING SERVICES OF JACKSONVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAVELLE R HARDIN (MANAGED CARE ANALYST)
(615) 344-8203
Entity
Organization
Contact information
Practice address
10475 CENTURIAN PARKWAY, JACKSONVILLE, FL 32256
(904) 928-1001
(904) 641-6298
Mailing address
10475 CENTURIAN PARKWAY, JACKSONVILLE, FL 32256
(904) 928-1001
(904) 641-6298
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V3323
BCBS OF FL
FL
Enumeration date
07/21/2008
Last updated
02/05/2009
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