Jackson Diagnostic Imaging, Inc

Primary specialty

Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X

Legal business name

JACKSON DIAGNOSTIC IMAGING, INC

Practice address

65 3Rd St NW
Suite 200
Winter Haven, FL 33881-4670

Phone

(863) 299-2424

Fax

(863) 299-4848

NPI assigned

Aug 19, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Sarelyn Bertina JacksonNPI 1790086841

Title

President/Ceo

Phone

(863) 299-2424

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sarelyn Bertina Jackson

  • Sonography Radiologic Technologist
  • Winter Haven, FL
  • NPI 1790086841
  NPD (past) Authorized official

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

{
    "created_epoch": "1250640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288915200000",
    "number": "1750513016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 3RD ST NW",
            "address_2": "SUITE 200",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814670",
            "telephone_number": "863-299-2424",
            "fax_number": "863-299-4848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 3RD ST NW",
            "address_2": "SUITE 200",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814670",
            "telephone_number": "863-299-2424",
            "fax_number": "863-299-4848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON DIAGNOSTIC IMAGING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-19",
        "last_updated": "2010-11-05",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "SARELYN",
        "authorized_official_middle_name": "BERTINA",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "863-299-2424",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Iskowitz, LCSW
• Esaam El-Dean Ismail, O.D.
• Sherif Isshak Ibrahim, MD
• J. Agustin Lacson M.D. Inc
• J&Y Assisted Living for the Ages
• Daniel Jackson, COTA
• Jillian J Jackson, LCSW
• Patrice Jackson
• Sarelyn Bertina Jackson
• Stephanie Kay Jackson

• Mobile Radiology Clinic/Center in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Mobile Radiology Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2010; 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.