Organization
JACKSONVILLE BEACHES MEDICAL IMAGING INC
Active
Other names
SOUTHSIDE 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
6138 KENNERLY RD, SUITE 101, JACKSONVILLE, FL 32216-4345
(904) 733-7770
(904) 733-7778
Mailing address
6138 KENNERLY RD, SUITE 101, JACKSONVILLE, FL 32216-4345
(904) 733-7770
(904) 733-7778
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCCR1418
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147878601
1ST HEALTH W/C #
FL
01
—
1840590
1ST HEALTH PROVIDER
FL
01
—
2052827
UNITED HEALTH CARE
FL
01
—
470001168
RR MEDICARE PIN
FL
01
—
7842141
AETNA PROVIDER #
FL
01
—
V2499
BCBS VIN #
FL
Enumeration date
09/30/2005
Last updated
10/02/2012
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