Provider Demographics
NPI:1609952845
Name:CENTRAL MASSACHUSETTS MAGNETIC IMAGING CENTER INC
Entity Type:Organization
Organization Name:CENTRAL MASSACHUSETTS MAGNETIC IMAGING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF CENTRAL MASSACHUSETTS MA
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:POLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-754-6026
Mailing Address - Street 1:367 PLANTATION STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-754-6026
Mailing Address - Fax:508-831-3715
Practice Address - Street 1:367 PLANTATION STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-754-6026
Practice Address - Fax:508-831-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4359261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1529676Medicaid
017269Medicare ID - Type Unspecified