NPIMap

Organization Active NPI

Medical Diagnostic Center of Jacksonville

  • Diagnostic Radiology Physician
  • Jacksonville, FL
National Provider Identifier
1164592218
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
HCC5331 Issued in FL
Legal business name
MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLE
Practice address
1400 Bishop Estates Rd
Jacksonville, FL 32259-4244
Phone
(904) 287-6263
Fax
(904) 287-6213
NPI assigned
Nov 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Nicolau Sacaquini
Title
Business Director
Phone
(904) 731-1556

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X HCC5331 FL Primary

Addresses

Primary practice location

1400 Bishop Estates Rd
Jacksonville, FL 32259-4244

Mailing address

PO Box 5606
Jacksonville, FL 32247-5606
Phone (904) 287-6263

Other identifiers 1

IdentifierTypeStateIssuer
V2764OtherFLBCBS PROVIDER NUMBER

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164592218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5606",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322475606",
            "telephone_number": "904-287-6263",
            "fax_number": "904-287-6213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BISHOP ESTATES RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322594244",
            "telephone_number": "904-287-6263",
            "fax_number": "904-287-6213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SACAQUINI",
        "authorized_official_first_name": "NICOLAU",
        "authorized_official_title_or_position": "BUSINESS DIRECTOR",
        "authorized_official_telephone_number": "904-731-1556",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "HCC5331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "V2764",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • 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.