Organization
MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLE
Active
Other names
SOUTHBANK IMAGING SERVICE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICOLAU SACAQUINI (BUSINESS DIRECTOR)
(904) 731-1556
Entity
Organization
Contact information
Practice address
1454 PRUDENTIAL DR, JACKSONVILLE, FL 32207-8132
(904) 493-2122
(904) 493-2125
Mailing address
PO BOX 5606, JACKSONVILLE, FL 32247-5606
(904) 493-2122
(904) 493-2125
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
HCC5333
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V2663
BCBS PROVIDER NUMBER
FL
Enumeration date
11/08/2006
Last updated
08/22/2020
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