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General NPI Number Information
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NPI Number | 1063564672
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Entity Type | Organization
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Legal Business Name | BEACHES OPEN MRI, LLC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 350 10TH AVE S
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-5136
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Country | US
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Telephone | 904-247-2220
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Fax | 904-247-2296
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Provider Business Mailing Address
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Address Line | 350 10TH AVE S
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-5136
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Country | US
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Telephone | 904-247-2220
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Fax | 904-247-2296
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Authorized Official
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Title or Position | RADIOLOGIST
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Name | MR. MARK S. FRISK
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Credential | M.D.
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Telephone | 904-247-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 0700012919
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License Number State | FL
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