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NPI Code Detail

MEDICARE: RIVERSIDE MEDICAL DIAGNOSTIC AND IMAGING, LLC

MEDICARE: RIVERSIDE MEDICAL DIAGNOSTIC AND IMAGING, 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
1261QR0200XRadiology Clinic/Center
2261QR0206XMammography Clinic/Center
3261QM1200XMagnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number : 1336378165
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERSIDE MEDICAL DIAGNOSTIC AND IMAGING, LLC
Provider Business Mailing Address
First Line : 2151 RIVERSIDE AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-4416
Country : US
Telephone Number : 904-389-6707
Fax Number : 904-389-6717
Provider Business Practice Location Address
First Line : 2151 RIVERSIDE AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-4416
Country : US
Telephone Number : 904-389-6707
Fax Number : 904-389-6717
Authorized Official
Title or Position : MANAGING PARTNER
Name : MR. CORBY MARSHALL
Credential :
Telephone Number : 912-253-0375
Provider Enumeration Date : 07/14/2009
Last Update Date : 09/28/2009

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Directions to “RIVERSIDE MEDICAL DIAGNOSTIC AND IMAGING, LLC ” Practice Location

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