OrganizationSan Bernardino Imaging Llc(Computerized Diagnostic Imaging Centers - San Bernardino)Clinic/CenterAmbulatory Health Care FacilitiesPractice Address1884 Business Center Dr, San Bernardino, CA 92408-3457(909) 890-4090PECOS EnrollmentBased on the most recent information from CMS, provider San Bernardino Imaging Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 3:36 PM.Profile DetailsProvider ID1164423612Provider TypeOrganizationFull NameSan Bernardino Imaging LlcOther NameComputerized Diagnostic Imaging Centers - San BernardinoSubpartNoEnumeration Date8/9/2005Last Updated3/18/2008Contact InformationPractice LocationPractice Address1884 Business Center Dr, San Bernardino, CA 92408-3457Phone(909) 890-4090Fax(909) 890-4051Mailing LocationMailing Address1884 Business Center Dr, San Bernardino, CA 92408-3457Phone(909) 890-4090Fax(909) 890-4051Authorized OfficialNameHardin, Lavelle (Credentialing Coordinator)Phone(615) 344-8203Provider TaxonomiesCodeDescriptionLicenseCode261QR0200XPrimaryDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseUnlisted IssuerCode261QM1200XDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseUnlisted IssuerCode261QR0206XDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerIDP00385820DescriptionOtherIssuerRR MEDICARECaliforniaIDIDTF00700DescriptionMedicaidIssuerUnlistedCalifornia