Provider Demographics
NPI:1699056135
Name:SOUTHERN CONNECTICUT IMAGING CENTERS, LLC
Entity type:Organization
Organization Name:SOUTHERN CONNECTICUT IMAGING CENTERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP- BUSINESS PROCESS MGT.
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-282-6000
Mailing Address - Street 1:26250 ENTERPRISE CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8406
Mailing Address - Country:US
Mailing Address - Phone:949-282-6026
Mailing Address - Fax:
Practice Address - Street 1:2543 DIXWELL AVE STE 100
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1860
Practice Address - Country:US
Practice Address - Phone:949-282-6026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology