Organization

Medfund Llc

May also be knows as Horizon St. Augustine Llc

Magnetic Resonance Imaging (MRI) Clinic/Center in St Augustine, FL(View on Map)

Legal Business Name

Medfund Llc

Also Known As

Horizon St. Augustine Llc

NPI Number

1841293982

NPI Type

Organization

Enumeration Date

05/23/2005

Specialties

(Taxonomies)

Code

261QM1200X

Primary Taxonomy

Yes

Licenses

State

Florida

License Number

HCC5205

Contact
Information

Purpose

Mailing
Location

Address

240 N WASHINGTON BLVD
200 SOUTHPARK BLVD

City

Sarasota
St Augustine

State

FL
FL

Postal Code

34236-5945
32086-3101

Country

US
US

Telephone Number

(941) 925-3490
(904) 819-0920

Authorized Official

Name

Mr. Martin Kern

Title or Position

SENIOR VICE PRESIDENT

Telephone Number

(941) 925-3490

Identifiers

Identifier

2302684
V2456
105715-15
7008104

Identifier State

Unknown
FL
FL
Unknown

Identifier Issuer

AETNA HMO #
BCBS PROVIDER #
CITRUS HMO
AETNA PPO/POS #

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 08/22/2020

Provider Address

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