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General NPI Number Information
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NPI Number | 1891899142
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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 | 09/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9759 SAN JOSE BLVD STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32257-5418
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Country | US
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Telephone | 904-260-4495
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Fax | 904-260-9539
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Provider Business Mailing Address
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Address Line | 9759 SAN JOSE BLVD STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32257-5418
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Country | US
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Telephone | 904-260-4495
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Fax | 904-260-9539
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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 | 858-455-7127
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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 |
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License Number State |
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