Provider Demographics
NPI:1306535950
Name:THE MEDICAL IMAGING PARTNERSHIP-JAX1 LLC
Entity type:Organization
Organization Name:THE MEDICAL IMAGING PARTNERSHIP-JAX1 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-384-3512
Mailing Address - Street 1:1540 BUSINESS CENTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4419
Mailing Address - Country:US
Mailing Address - Phone:904-807-5272
Mailing Address - Fax:904-389-8699
Practice Address - Street 1:10696 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1000
Practice Address - Country:US
Practice Address - Phone:904-996-8100
Practice Address - Fax:904-389-8699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MEDICAL IMAGING PARTNERSHIP-JAX1 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-01
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology