Healthcare Provider Details

I. General information

NPI: 1699056135
Provider Name (Legal Business Name): SOUTHERN CONNECTICUT IMAGING CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2543 DIXWELL AVE STE 100
HAMDEN CT
06514-1860
US

IV. Provider business mailing address

26250 ENTERPRISE CT SUITE 100
LAKE FOREST CA
92630-8406
US

V. Phone/Fax

Practice location:
  • Phone: 949-282-6026
  • Fax:
Mailing address:
  • Phone: 949-282-6026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA R. BLANK
Title or Position: EVP- BUSINESS PROCESS MGT.
Credential:
Phone: 949-282-6000