Provider Demographics
NPI:1467554303
Name:REGIONAL MRI OF JACKSONVILLE, INC.
Entity Type:Organization
Organization Name:REGIONAL MRI OF JACKSONVILLE, INC.
Other - Org Name:FIRST CHOICE IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-455-7217
Mailing Address - Street 1:9872 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5457
Mailing Address - Country:US
Mailing Address - Phone:904-260-2805
Mailing Address - Fax:904-260-9190
Practice Address - Street 1:9872 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5457
Practice Address - Country:US
Practice Address - Phone:904-260-2805
Practice Address - Fax:904-260-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4877293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory