Healthcare Provider Details

I. General information

NPI: 1144466293
Provider Name (Legal Business Name): JCC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 04/30/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5692 FAR HILLS AVE SUITE 1H
DAYTON OH
45429-2202
US

IV. Provider business mailing address

15371 HEMLOCK POINT ROAD
CHAGRIN FALLS OH
44022-3801
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-3384
  • Fax: 937-438-3394
Mailing address:
  • Phone: 855-734-2645
  • Fax: 855-734-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACK CHAMPNEY CORNELL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 440-223-8848