Provider Demographics
NPI:1538167192
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:904-545-3591
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:2005-07-08
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3853335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPIN#1365 102533OtherAVMED
FL606011OtherPRINCIPAL
FLU1227Medicare ID - Type UnspecifiedIDTF MOBILE ULTRASOUND
FL606011OtherPRINCIPAL