MEDICARE: CORVALLIS MRI A JOINT VENTURE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist
2	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952529620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORVALLIS MRI A JOINT VENTURE

Provider Business Mailing Address
First Line	:	3600 NW SAMARITAN DR
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97330-5472
Country	:	US
Telephone Number	:	541-768-5187
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 NW SAMARITAN DRIVE
Second Line	:	SUITE 101
City	:	CORVALLIS
State	:	OR
Zip	:	97330-3737
Country	:	US
Telephone Number	:	541-768-5187
Fax Number	:	541-768-5092

Authorized Official
Title or Position	:	CEO - GSRMC
Name	:	JOSIAH JOHNSON
Credential	:
Telephone Number	:	541-768-5009

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	04/07/2026

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