MEDICARE: UNIVERSITY MEDICAL IMAGING PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144262551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY MEDICAL IMAGING PC

Provider Business Mailing Address
First Line	:	4901 LAC DE VILLE BLVD
Second Line	:	SUITE 140
City	:	ROCHESTER
State	:	NY
Zip	:	14618-5647
Country	:	US
Telephone Number	:	585-341-9065
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 LAC DE VILLE BLVD
Second Line	:	SUITE 140
City	:	ROCHESTER
State	:	NY
Zip	:	14618-5647
Country	:	US
Telephone Number	:	585-341-9065
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	CHRISTINE M MENKE
Credential	:
Telephone Number	:	585-275-5969

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	08/22/2020

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Directions to “UNIVERSITY MEDICAL IMAGING PC ” Practice Location

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