Organization
NATIONAL PET SCAN DUVAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANA LYNN WILSON (PROJECT MANAGER)
(904) 358-8441
Entity
Organization
Contact information
Practice address
425 N LEE ST, JACKSONVILLE, FL 32204-1127
(904) 861-6000
(904) 861-6007
Mailing address
1 INDEPENDENT DR, STE 2201, JACKSONVILLE, FL 32202-5015
(904) 358-8441
(904) 358-2288
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCC5690
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730079-001
CIGNA
FL
01
—
201709
WELLCARE
FL
01
—
3190985
AETNA HMO
FL
01
—
593688943
HUMANA
FL
01
—
7051350
AETNA NON HMO
FL
01
—
V2569
BLUE CROSS BLUE SHIELD FL
FL
Enumeration date
05/24/2005
Last updated
02/27/2012
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