Provider Demographics
NPI:1669431441
Name:NORTH COUNTRY PRECISION MEDICAL IMAGING, PC
Entity type:Organization
Organization Name:NORTH COUNTRY PRECISION MEDICAL IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIPAA COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:CCSP
Authorized Official - Phone:315-782-2620
Mailing Address - Street 1:1116 ARSENAL ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2229
Mailing Address - Country:US
Mailing Address - Phone:315-782-2620
Mailing Address - Fax:315-788-4980
Practice Address - Street 1:ALICE HYDE HOSPITAL
Practice Address - Street 2:133 PARK ST
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953
Practice Address - Country:US
Practice Address - Phone:315-782-2620
Practice Address - Fax:315-788-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56520AMedicare ID - Type Unspecified