Provider Demographics
NPI:1538153671
Name:MEDICAL IMAGING CENTER LLP
Entity type:Organization
Organization Name:MEDICAL IMAGING CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-234-7608
Mailing Address - Street 1:PO BOX 2004
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4504
Mailing Address - Country:US
Mailing Address - Phone:315-362-5285
Mailing Address - Fax:315-445-2936
Practice Address - Street 1:5008 BRITTONFIELD PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9248
Practice Address - Country:US
Practice Address - Phone:315-234-7600
Practice Address - Fax:315-472-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN0467OtherRRMCR
NY00853663Medicaid
39592AMedicare PIN