EVERGREEN IMAGING CENTER LLC NPI 1316050925

NPI Information

NPI: 1316050925
Provider Name: EVERGREEN IMAGING CENTER, LLC
Classification: Clinic/Center - 261QR0200X
Specialization: Radiology
Entity Type: Organization
Address: 2800 TAMARACK AVE
SUITE 002
SOUTH WINDSOR, CT
ZIP 06074
Phone: (860) 533-4600

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NPI Details

EVERGREEN IMAGING CENTER, LLC is a radiology clinic center in South Windsor, CT. EVERGREEN IMAGING CENTER, LLC NPI is 1316050925. The provider is registered as an organization entity type.

The provider's business location address is:

2800 TAMARACK AVE
SUITE 002
SOUTH WINDSOR, CT
ZIP 06074
Phone: (860) 533-4600
Fax: (860) 533-4601

The provider's authorized official is Dennis Patrick Mcconville .
The authorized official title is Director and has the following contact phone number (860) 533-3429.

The enumeration date for this NPI number is 8/16/2006 and was last updated on 11/10/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0200X	Clinic/Center	Radiology			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	004261351	MEDICAID	CONNECTICUT
2	C03509	MEDICARE ID-TYPE UNSPECIFIED	CONNECTICUT	GROUP NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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