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General NPI Number Information
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NPI Number | 1891892493
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Entity Type | Organization
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Legal Business Name | REGIONAL MRI OF JACKSONVILLE
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Dates
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Enumeration Date | 09/19/2006
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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
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Country | US
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Telephone | 904-260-2805
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 201672
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City | DALLAS
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State | TX
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Zip | 75320-1672
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Country | US
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Telephone | 904-260-2805
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MS. LESLIE G WEBER
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Credential |
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Telephone | 858-455-7127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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