Provider Demographics
NPI:1992708580
Name:DAVIS DIAGNOSTICS LLC
Entity type:Organization
Organization Name:DAVIS DIAGNOSTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-677-8680
Mailing Address - Street 1:240 N WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5945
Mailing Address - Country:US
Mailing Address - Phone:941-925-3490
Mailing Address - Fax:941-953-4452
Practice Address - Street 1:290 CLYDE MORRIS BLVD
Practice Address - Street 2:STE C1
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8204
Practice Address - Country:US
Practice Address - Phone:386-677-8680
Practice Address - Fax:386-677-6895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC1817-EXEMPT261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2694OtherBCBS PROV #
FLV2694OtherBCBS PROV #