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General NPI Number Information
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NPI Number | 1134660319
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Entity Type | Organization
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Legal Business Name | CC IMAGING LLC
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 174 STRAUB RD
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City | ROCHESTER
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State | NY
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Zip | 14626-4254
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Country | US
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Telephone | 585-746-7078
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Fax |
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Provider Business Mailing Address
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Address Line | 174 STRAUB RD
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City | ROCHESTER
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State | NY
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Zip | 14626-4254
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Country | US
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Telephone | 585-746-7078
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SANDRA ANN CROWDER
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Credential |
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Telephone | 585-746-7078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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