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General NPI Number Information
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NPI Number | 1467554303
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Entity Type | Organization
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Legal Business Name | REGIONAL MRI OF JACKSONVILLE, INC.
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9872 SAN JOSE BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-5457
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Country | US
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Telephone | 904-260-2805
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Fax | 904-260-9190
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Provider Business Mailing Address
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Address Line | 9872 SAN JOSE BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-5457
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Country | US
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Telephone | 904-260-2805
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Fax | 904-260-9190
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Authorized Official
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Title or Position | COO
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Name | LESLIE G. WEBER
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Credential |
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Telephone | 858-455-7217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number | HCC4877
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License Number State | FL
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