Provider Demographics
NPI:1588829170
Name:JACKSONVILLE ORTHOPAEDIC INSTITUTE INC
Entity Type:Organization
Organization Name:JACKSONVILLE ORTHOPAEDIC INSTITUTE INC
Other - Org Name:JACKSONVILLE ORTHOPAEDIC MRI
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICCHINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-346-3465
Mailing Address - Street 1:PO BOX 117345
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7345
Mailing Address - Country:US
Mailing Address - Phone:904-346-3465
Mailing Address - Fax:904-858-6490
Practice Address - Street 1:4339 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2004
Practice Address - Country:US
Practice Address - Phone:904-389-8570
Practice Address - Fax:904-389-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24314Medicare PIN