MEDICARE: MEDICAL MRI GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154690550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL MRI GROUP LLC

Provider Business Mailing Address
First Line	:	7999 PHILIPS HWY
Second Line	:	SUITE 311
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4443
Country	:	US
Telephone Number	:	904-683-6667
Fax Number	:	904-683-8419

Provider Business Practice Location Address
First Line	:	7999 PHILIPS HWY
Second Line	:	SUITE 311
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4443
Country	:	US
Telephone Number	:	904-683-6667
Fax Number	:	904-683-8419

Authorized Official
Title or Position	:	CEO
Name	:	MRS. NINI WASHBURN
Credential	:
Telephone Number	:	501-442-5207

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	05/16/2025

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