Provider Demographics
NPI:1669786323
Name:CENTRAL MASSACHUSETTS MAGNETIC IMAGING CENTER, INC.
Entity type:Organization
Organization Name:CENTRAL MASSACHUSETTS MAGNETIC IMAGING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:POLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-754-6026
Mailing Address - Street 1:367 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2323
Mailing Address - Country:US
Mailing Address - Phone:508-754-6026
Mailing Address - Fax:508-831-3715
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:SUITE H1-713
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:774-443-0500
Practice Address - Fax:508-831-3715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL MASSACHUSETTS MAGNETIC IMAGING CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4359261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1529676Medicaid
MA1529676Medicaid