Provider Demographics
NPI:1700130010
Name:PRECISION IMAGING ST. AUGUSTINE, LLC
Entity Type:Organization
Organization Name:PRECISION IMAGING ST. AUGUSTINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-996-8100
Mailing Address - Street 1:PO BOX 96418
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28296-0418
Mailing Address - Country:US
Mailing Address - Phone:904-996-8100
Mailing Address - Fax:904-389-8699
Practice Address - Street 1:1000 PLANTATION ISLAND DR S
Practice Address - Street 2:SUITE 1
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3100
Practice Address - Country:US
Practice Address - Phone:904-996-8100
Practice Address - Fax:904-996-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology