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General NPI Number Information
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NPI Number | 1144466293
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Entity Type | Organization
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Legal Business Name | JCC, LLC
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Dates
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Enumeration Date | 12/19/2008
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 5692 FAR HILLS AVE SUITE 1H
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City | DAYTON
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State | OH
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Zip | 45429-2202
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Country | US
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Telephone | 937-438-3384
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Fax | 937-438-3394
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Provider Business Mailing Address
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Address Line | 15371 HEMLOCK POINT ROAD
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City | CHAGRIN FALLS
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State | OH
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Zip | 44022-3801
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Country | US
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Telephone | 855-734-2645
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Fax | 855-734-2645
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | JACK CHAMPNEY CORNELL
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Credential |
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Telephone | 440-223-8848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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