Healthcare Provider Details

I. General information

NPI: 1134660319
Provider Name (Legal Business Name): CC IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 STRAUB RD
ROCHESTER NY
14626-4254
US

IV. Provider business mailing address

174 STRAUB RD
ROCHESTER NY
14626-4254
US

V. Phone/Fax

Practice location:
  • Phone: 585-746-7078
  • Fax:
Mailing address:
  • Phone: 585-746-7078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA ANN CROWDER
Title or Position: OWNER
Credential:
Phone: 585-746-7078