Provider Demographics
NPI:1851356919
Name:SOUTHERN CONNECTICUT IMAGING CENTERS LLC
Entity Type:Organization
Organization Name:SOUTHERN CONNECTICUT IMAGING CENTERS LLC
Other - Org Name:WHITNEY IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP BUSINESS PROCESS MANAGEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-282-6000
Mailing Address - Street 1:PO BOX 846044
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-6044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3691
Practice Address - Country:US
Practice Address - Phone:203-288-3068
Practice Address - Fax:203-288-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT470001376OtherRAILROAD MEDICARE
CT04216322Medicaid
CT470000013Medicare PIN