First Coast Imaging, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME0052228 Issued in FL

Legal business name

FIRST COAST IMAGING, LLC

Doing business as

Select Diagnostics

Practice address

159 N 3Rd St
Macclenny, FL 32063-2103

Phone

(904) 733-7800

Fax

(904) 419-4888

NPI assigned

May 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Juan C. Luis-Jorge, M.D.

Title

Medical Director

Phone

(904) 733-7800

Specialties & licenses 1

Addresses

Other names 1

• Select Diagnostics Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053523670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 N 3RD ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320632103",
            "telephone_number": "904-653-4645",
            "fax_number": "904-653-4637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 N 3RD ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320632103",
            "telephone_number": "904-733-7800",
            "fax_number": "904-419-4888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST COAST IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LUIS-JORGE",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "904-733-7800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME0052228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Select Diagnostics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cristin Ellis
• Alexandra Erbesti
• Alanna D Eubanks, RD, LD/N
• Tara Evans
• Danielle Grace Fender
• Florida Department of Children and Families (Northeast Florida State Hospital)
• Florida Department of Children and Families (NortheastFloridaStateHospitalCommunityBehavioralHealthcareServices)
• Florida Department of Health (Baker County Health Department)
• Foundations: Speech, Language and Learning Services
• Mary Martha Futch, O.D.

• Specialist in Macclenny, FL
• Providers in Macclenny, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.