Provider Demographics
NPI:1447408299
Name:TOLLAND IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:TOLLAND IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCCONVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-533-3429
Mailing Address - Street 1:111 FOUNDERS PLZ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3212
Mailing Address - Country:US
Mailing Address - Phone:860-246-6589
Mailing Address - Fax:860-783-5733
Practice Address - Street 1:6 FIELDSTONE CMNS
Practice Address - Street 2:SUITE E
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3419
Practice Address - Country:US
Practice Address - Phone:860-896-4848
Practice Address - Fax:860-896-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008001571Medicaid
CT15MRI0179CT01OtherANTHEM BC/BS
786889OtherCONNECTICARE