Beaches Open MRI, LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

0700012919 Issued in FL

Legal business name

BEACHES OPEN MRI, LLC

Practice address

350 10TH Ave S
Jacksonville Beach, FL 32250-5136

Phone

(904) 247-2220

Fax

(904) 247-2296

NPI assigned

Jan 17, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Mark S. Frisk, M.D.

Title

Radiologist

Phone

(904) 247-2220

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327363200000",
    "number": "1063564672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 10TH AVE S",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322505136",
            "telephone_number": "904-247-2220",
            "fax_number": "904-247-2296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 10TH AVE S",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322505136",
            "telephone_number": "904-247-2220",
            "fax_number": "904-247-2296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACHES OPEN MRI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2012-01-24",
        "status": "A",
        "authorized_official_last_name": "FRISK",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "RADIOLOGIST",
        "authorized_official_telephone_number": "904-247-2220",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "FL",
            "license": "0700012919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER #",
            "identifier": "2240835",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "38350",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "V2353",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Radiology Clinic/Center in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Radiology Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; 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.