Provider Demographics
NPI:1922151695
Name:HEALTHCENTER IMAGING OF FAIRFIELD COUNTY LLC
Entity Type:Organization
Organization Name:HEALTHCENTER IMAGING OF FAIRFIELD COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-870-8611
Mailing Address - Street 1:999 SILVER LN
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5343
Mailing Address - Country:US
Mailing Address - Phone:203-870-8611
Mailing Address - Fax:203-612-4697
Practice Address - Street 1:999 SILVER LN
Practice Address - Street 2:SUITE 1B
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5343
Practice Address - Country:US
Practice Address - Phone:203-378-4200
Practice Address - Fax:203-612-4697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD300008953Medicare PIN