Healthcare Provider Details

I. General information

NPI: 1700833472
Provider Name (Legal Business Name): SISKIYOU IMAGING,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 MAPLE ST
ASHLAND OR
97520-1552
US

IV. Provider business mailing address

278 MAPLE ST
ASHLAND OR
97520-1552
US

V. Phone/Fax

Practice location:
  • Phone: 541-201-4500
  • Fax:
Mailing address:
  • Phone: 541-201-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number080223 94
License Number StateOR

VIII. Authorized Official

Name: MS. JUDITH A GUSS
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 541-773-2493