Organization
JACKSONVILLE BEACHES MEDICAL IMAGING INC
Active
Other names
JACKSONVILLE 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
2700 RIVERSIDE AVE, SUITE 1, JACKSONVILLE, FL 32205-8275
(904) 381-9994
(904) 389-6866
Mailing address
2700 RIVERSIDE AVE, SUITE 1, JACKSONVILLE, FL 32205-8275
(904) 381-9994
(904) 389-6866
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCCR1430
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147878902
1ST HEALTH W/C #
FL
01
—
1840590
1ST HEALTH PROVIDER #
FL
01
—
2000441
UNITED HEALTH CARE
FL
01
—
470001666
RR MEDICARE PROVIDER #
FL
01
—
7842141
AETNA PROVIDER #
FL
01
—
V2622
BCBS FL PIN #
FL
Enumeration date
09/30/2005
Last updated
10/02/2012
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