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
—
—
261QR0200X
Radiology Clinic/Center
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Enumeration date
07/14/2009
Last updated
09/28/2009
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