Provider Demographics
NPI:1538333117
Name:ASCENT DIAGNOSTIC IMAGING OF JACKSONVILLE LLC
Entity Type:Organization
Organization Name:ASCENT DIAGNOSTIC IMAGING OF JACKSONVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-496-1075
Mailing Address - Street 1:5210 BELFORT RD
Mailing Address - Street 2:STE 130
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6024
Mailing Address - Country:US
Mailing Address - Phone:904-470-4000
Mailing Address - Fax:
Practice Address - Street 1:5210 BELFORT RD
Practice Address - Street 2:STE 130
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6024
Practice Address - Country:US
Practice Address - Phone:904-470-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME595482085B0100X, 2085D0003X, 2085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty