Provider Demographics
NPI:1154690550
Name:MEDICAL MRI GROUP LLC
Entity Type:Organization
Organization Name:MEDICAL MRI GROUP LLC
Other - Org Name:BAYMEADOWS MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-226-7117
Mailing Address - Street 1:7999 PHILIPS HWY
Mailing Address - Street 2:SUITE 311
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4443
Mailing Address - Country:US
Mailing Address - Phone:904-683-6667
Mailing Address - Fax:904-683-8419
Practice Address - Street 1:7999 PHILIPS HWY
Practice Address - Street 2:SUITE 311
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4443
Practice Address - Country:US
Practice Address - Phone:904-683-6667
Practice Address - Fax:904-683-8419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)