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Organization
EVERGREEN IMAGING CENTER, LLC
Active
Organization
EVERGREEN IMAGING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS PATRICK MCCONVILLE (DIRECTOR)
(860) 533-3429
Entity
Organization
Contact information
Practice address
2800 TAMARACK AVE, SUITE 002, SOUTH WINDSOR, CT 06074
(860) 533-4600
(860) 533-4601
Mailing address
2800 TAMARACK AVE, SUITE 002, SOUTH WINDSOR, CT 06074
(860) 533-4600
(860) 533-4601
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004261351
—
CT
Enumeration date
08/16/2006
Last updated
11/10/2008
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