Organization
JACKSONVILLE BEACHES MEDICAL IMAGING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CATHY BLAESE (CHIEF OPERATING OFFICER)
(904) 241-7772
Entity
Organization
Contact information
Practice address
3316 3RD ST S, SUITE 101, JACKSONVILLE BEACH, FL 32250-6073
(904) 241-7772
(904) 241-7702
Mailing address
3316 3RD ST S, SUITE 101, JACKSONVILLE BEACH, FL 32250-6073
(904) 241-7772
(904) 241-7702
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCCR1416
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1416
HEALTH CARE CLINIC REG
FL
01
—
147878900
1ST HEALTH W/C ID
FL
01
—
1840590
FIRST HEALTH ID
FL
01
—
470001169
RR MEDICARE
FL
01
—
V2405
BCBS PROVIDER #
FL
Enumeration date
09/29/2005
Last updated
10/02/2012
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