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General NPI Number Information
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NPI Number | 1922396779
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL DIAGNOSTIC READING MRI INC.
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Dates
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Enumeration Date | 07/14/2011
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 3728 PHILLIPS HWY STE34
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City | JACKSONVILLE
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State | FL
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Zip | 32207-9300
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Country | US
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Telephone | 904-399-2500
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Fax | 904-399-2495
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Provider Business Mailing Address
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Address Line | 3728 PHILLIPS HWY STE34
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City | JACKSONVILLE
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State | FL
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Zip | 32207-9300
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Country | US
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Telephone | 904-399-2500
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Fax | 904-399-2495
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Authorized Official
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Title or Position | CFO
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Name | JOSE VIVAS
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Credential |
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Telephone | 904-399-2500
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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 | 1000032322
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number | 1000032322
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License Number State | FL
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