Healthcare Provider Details

I. General information

NPI: 1538153671
Provider Name (Legal Business Name): MEDICAL IMAGING CENTER LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 BRITTONFIELD PKWY SUITE 100
EAST SYRACUSE NY
13057-9248
US

IV. Provider business mailing address

PO BOX 2004
EAST SYRACUSE NY
13057-4504
US

V. Phone/Fax

Practice location:
  • Phone: 315-234-7600
  • Fax: 315-472-0530
Mailing address:
  • Phone: 315-362-5285
  • Fax: 315-445-2936

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: MARY ANN DRUMM
Title or Position: CEO
Credential:
Phone: 315-234-7608