Organization
MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLE
Active
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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