Provider Demographics
NPI:1497196208
Name:GREATER JACKSONVILLE LITHOTRIPSY SERVICES LLC
Entity Type:Organization
Organization Name:GREATER JACKSONVILLE LITHOTRIPSY SERVICES LLC
Other - Org Name:LSGJ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-370-3366
Mailing Address - Street 1:7003 CHADWICK DR
Mailing Address - Street 2:STE 321
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5232
Mailing Address - Country:US
Mailing Address - Phone:615-370-3366
Mailing Address - Fax:615-371-1887
Practice Address - Street 1:7003 CHADWICK DR
Practice Address - Street 2:STE 321
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5232
Practice Address - Country:US
Practice Address - Phone:615-370-3366
Practice Address - Fax:615-371-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier