Healthcare Provider Details

I. General information

NPI: 1659970168
Provider Name (Legal Business Name): CENTRAL OREGON RADIOLOGY ASSOC., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 SW CHANDLER AVE STE 202
BEND OR
97702-3240
US

IV. Provider business mailing address

1460 NE MEDICAL CENTER DR
BEND OR
97701-6061
US

V. Phone/Fax

Practice location:
  • Phone: 541-312-5522
  • Fax: 541-382-2719
Mailing address:
  • Phone: 541-382-6633
  • Fax: 541-382-2719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAMIE DYER
Title or Position: CHIEF PATIENT ADMIN SRVS OFFICER
Credential:
Phone: 541-598-3232