MEDICARE: REGIONAL MRI OF JACKSONVILLE, INC.

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1891899142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL MRI OF JACKSONVILLE, INC.

Provider Business Mailing Address
First Line	:	9759 SAN JOSE BLVD STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5418
Country	:	US
Telephone Number	:	904-260-4495
Fax Number	:	904-260-9539

Provider Business Practice Location Address
First Line	:	9759 SAN JOSE BLVD STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5418
Country	:	US
Telephone Number	:	904-260-4495
Fax Number	:	904-260-9539

Authorized Official
Title or Position	:	COO
Name	:	LESLIE G. WEBER
Credential	:
Telephone Number	:	858-455-7127

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	08/22/2020

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