NPIMap

Organization Active NPI

Medical Diagnostic Center of Jacksonville

Doing business as Southbank Imaging Service

  • Diagnostic Radiology Physician
  • Jacksonville, FL
National Provider Identifier
1730259896
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
HCC5333 Issued in FL
Legal business name
MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLE
Doing business as
Southbank Imaging Service
Practice address
1454 Prudential Dr
Jacksonville, FL 32207-8132
Phone
(904) 493-2122
Fax
(904) 493-2125
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 HCC5333 FL Primary

Addresses

Primary practice location

1454 Prudential Dr
Jacksonville, FL 32207-8132

Mailing address

PO Box 5606
Jacksonville, FL 32247-5606
Phone (904) 493-2122

Other identifiers 1

IdentifierTypeStateIssuer
V2663OtherFLBCBS PROVIDER NUMBER

Other names 1

  • SOUTHBANK IMAGING SERVICE Doing business as

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": "1730259896",
    "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": "904-493-2122",
            "fax_number": "904-493-2125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1454 PRUDENTIAL DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078132",
            "telephone_number": "904-493-2122",
            "fax_number": "904-493-2125"
        }
    ],
    "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": "HCC5333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "V2663",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHBANK IMAGING SERVICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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.