Provider Demographics
NPI:1043233380
Name:JACKSONVILLE MOBILE IMAGING SERVICES INC
Entity Type:Organization
Organization Name:JACKSONVILLE MOBILE IMAGING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RT,NMT
Authorized Official - Phone:904-296-0353
Mailing Address - Street 1:4237 SALISBURY RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8029
Mailing Address - Country:US
Mailing Address - Phone:904-296-0353
Mailing Address - Fax:904-296-9403
Practice Address - Street 1:4237 SALISBURY RD
Practice Address - Street 2:SUITE 306
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8029
Practice Address - Country:US
Practice Address - Phone:904-296-0353
Practice Address - Fax:904-296-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3853261QR0208X, 293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPIN#1365 102533OtherAVMED
FL606011OtherPRINCIPAL
FL630000562OtherRAILROAD MEDICARE
FL606011OtherPRINCIPAL