Medical Diagnostic Center of Jacksonville

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLE

Practice address

3716 University Blvd S Ste 2
Jacksonville, FL 32216-4318

Phone

(904) 446-9093

Fax

(904) 446-9095

NPI assigned

Mar 14, 2008

Organization subpart

Yes

Parent organization

MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLEAs reported in NPPES

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

Authorized official

Name

Keesha Compton

Title

Billing Supervisor

Phone

(904) 731-1556

Specialties & licenses 1

Addresses

Other names 1

• MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLE Other name

Part of

Medical Diagnostic Center

Locations

Practitioners 2

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

• Scott David Wiedenmann, M.D.

  • Diagnostic Radiology Physician
  • Ponte Vedra Beach, FL
  • NPI 1245340744
  NPD (past)
• Gurvan E. Blackman, MD

  • Vascular & Interventional Radiology Physician
  • Hamilton, NJ
  • NPI 1215099833
  NPD (past)

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

{
    "created_epoch": "1205452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226275200000",
    "number": "1982875217",
    "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": "904-446-9093",
            "fax_number": "904-446-9095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3716 UNIVERSITY BLVD S STE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164318",
            "telephone_number": "904-446-9093",
            "fax_number": "904-446-9095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLE",
        "enumeration_date": "2008-03-14",
        "last_updated": "2008-11-10",
        "status": "A",
        "authorized_official_last_name": "COMPTON",
        "authorized_official_first_name": "KEESHA",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "904-731-1556"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Medical Care Products Inc
• Medical Diagnostic Center of Jacksonville
• Medical Diagnostic Center of Jacksonville
• Medical Diagnostic Center of Jacksonville
• Medical Diagnostic Center of Jacksonville
• Medical Diagnostic Professional Management
• Medical Examiner'S Office
• Medical Mechanics, Inc.
• Medical MRI Group LLC
• Medical Nutrition Therapy of Florida, Inc.

• Radiology Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, 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 Nov 10, 2008; 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.