SAN JOSE IMAGING CENTER LLC (NPI# 1083802805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083802805 |
| Entity Type | Organization |
| Organization Name | SAN JOSE IMAGING CENTER LLC |
| Other Organization Name | INNOVATIVE IMAGING JACKSONVILLE |
| Practice Address |
10696 Old Saint Augustine Rd Jacksonville FL 32257-1000 |
| Mailing Address |
Po Box 270543 Tampa FL 33688-0543 |
| Practice Telephone | 9042681080 |
| Practice Fax Number | 9042683060 |
| Mailing Telephone | 8504781312 |
| Mailing Fax Number | 8504749060 |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2020-10-05 |
| Authorized Official Name | MR. PAUL STANLEY (CEO) |
| Authorized Official Telephone | 8136905720 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0200X |
Clinic/Center Specialization: Radiology |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Innovative Imaging Jacksonville | Doing Business As Name - Organization |
| Street Address |
10696 OLD SAINT AUGUSTINE RD |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32257-1000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740835842 | Majdoline Kasera | Pharmacist | 11250-4 Old St Augustine Rd, Jacksonville, FL 32257 | 2019-08-06 |
| 1386203859 | Jetaime Y Lewis | Physical Therapist | 9765 San Jose Blvd Ste 6, Jacksonville, FL 32257 | 2019-06-10 |
| 1437622107 | Michelle Espanol Garcia | Nurse Practitioner | 9957 Moorings Dr Ste 204, Jacksonville, FL 32257 | 2019-01-05 |
| 1982172995 | Pacifica Augustine Road LLC | Alzheimer Center (Dementia Center) | 10660 Old Augustine Road, Jacksonville, FL 32257 | 2018-11-07 |
| 1659860492 | Andrea Leigh Miller | Social Worker | 10416 Spotted Fawn Lane, Jacksonville, FL 32257 | 2018-05-08 |
| 1376049965 | Stephanie Lynne Jordon | Nurse Practitioner | 9765 San Jose Blvd Ste 102, Jacksonville, FL 32257 | 2018-04-02 |
| 1205335619 | Annetta Aileen Brown | Respite Care | 4901 Sunbeam Rd Apt 1016, Jacksonville, FL 32257 | 2018-02-12 |
| 1841714888 | Freda Stevens | Counselor | 9521 Shellie Road Unit 13, Jacksonville, FL 32257 | 2017-08-01 |
| 1659821353 | Jennifer Lavoro | Acupuncturist | 11259 Thomaston Pl, Jacksonville, FL 32257 | 2016-10-06 |
| 1225488232 | Avenues Dental LLC | Dentist | 6144 Gazebo Park Place South, Ste 210, Jacksonville, FL 32257 | 2016-06-21 |
| Find all providers in zip 32257 | ||||
| Taxonomy Code | 261QR0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487934311 | Gate Parkway Diagnostic Center Inc | Clinic/Center | 8075 Gate Pkwy W Ste 302, Jacksonville, FL 32216-3685 | 2011-08-23 |
| 1982875217 | Medical Diagnostic Center of Jacksonville | Clinic/Center | 3716 University Blvd S Ste 2, Jacksonville, FL 32216-4318 | 2008-03-14 |
| 1750405114 | Signet Diagnostic Imaging Services North Florida LLC | Clinic/Center | 4171 Roosevelt Blvd, Jacksonville, FL 32210-1837 | 2007-03-19 |
| 1225138787 | Radiology Health Imaging, LLC | Clinic/Center | 12404 Hatton Chase Lane West, Jacksonville, FL 32258 | 2006-09-25 |
| 1558375469 | Monument-9a Imaging & Diagnostic Center L L C | Clinic/Center | 1201 Monument Rd Ste 101, Jacksonville, FL 32225-6494 | 2006-07-28 |
| 1104849280 | The Medical Imaging Partnership Jax1 LLC | Clinic/Center | 7860 Gate Parkway, Suite 123, Jacksonville, FL 32256-7279 | 2006-07-26 |
| 1821050923 | Omi of Jacksonville Inc | Clinic/Center | 3716 University Blvd South, Jacksonville, FL 32216 | 2006-04-04 |
| 1538159819 | Allied Mobile Sono, Inc. | Clinic/Center | 3545 Saint Johns Bluff Rd S, Suite 1 # 274, Jacksonville, FL 32224-2682 | 2005-10-26 |
| 1568459055 | Jacksonville Beaches Medical Imaging Inc | Clinic/Center | 6138 Kennerly Rd, Suite 101, Jacksonville, FL 32216-4345 | 2005-09-30 |
| 1548257041 | Jacksonville Beaches Medical Imaging Inc | Clinic/Center | 2700 Riverside Ave, Suite 1, Jacksonville, FL 32205-8275 | 2005-09-30 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32257 |
Please comment or provide details below to improve the information on SAN JOSE IMAGING CENTER LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.