NPIMap

Organization Active NPI

Evergreen Imaging Center, LLC

  • Radiology Clinic/Center
  • South Windsor, CT
National Provider Identifier
1316050925
Registry record updated Nov 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
EVERGREEN IMAGING CENTER, LLC
Practice address
2800 Tamarack Ave
Suite 002
South Windsor, CT 06074
Phone
(860) 533-4600
Fax
(860) 533-4601
NPI assigned
Aug 16, 2006
Last updated
Nov 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Dennis Patrick McConville
Title
Director
Phone
(860) 533-3429

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

2800 Tamarack Ave
Suite 002
South Windsor, CT 06074

Mailing address

2800 Tamarack Ave
Suite 002
South Windsor, CT 06074
Phone (860) 533-4600

Other identifiers 1

IdentifierTypeStateIssuer
004261351MedicaidCT

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226275200000",
    "number": "1316050925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 TAMARACK AVE",
            "address_2": "SUITE 002",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "06074",
            "telephone_number": "860-533-4600",
            "fax_number": "860-533-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 TAMARACK AVE",
            "address_2": "SUITE 002",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "06074",
            "telephone_number": "860-533-4600",
            "fax_number": "860-533-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN IMAGING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2008-11-10",
        "status": "A",
        "authorized_official_last_name": "MCCONVILLE",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "860-533-3429",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004261351",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Windsor, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.