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Organization
RIVERSIDE MEDICAL DIAGNOSTIC AND IMAGING, LLC
Active
Organization
RIVERSIDE MEDICAL DIAGNOSTIC AND IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORBY MARSHALL (MANAGING PARTNER)
(912) 253-0375
Entity
Organization
Contact information
Practice address
2151 RIVERSIDE AVE, JACKSONVILLE, FL 32204-4416
(904) 389-6707
(904) 389-6717
Mailing address
2151 RIVERSIDE AVE, JACKSONVILLE, FL 32204-4416
(904) 389-6707
(904) 389-6717
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
NULL
261QR0200X
Radiology Clinic/Center
—
NULL
261QR0206X
Mammography Clinic/Center
—
NULL
Other
Enumeration date
07/14/2009
Last updated
09/28/2009
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