Healthcare Provider Details

I. General information

NPI: 1275655755
Provider Name (Legal Business Name): MEDFORD OPEN MRI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 5TH ST SUITE 3
BROOKINGS OR
97415-9702
US

IV. Provider business mailing address

205 LIBERTY ST NE SUITE B
SALEM OR
97301-3586
US

V. Phone/Fax

Practice location:
  • Phone: 541-469-2170
  • Fax:
Mailing address:
  • Phone: 503-586-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RANDY FUJIOKA
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 503-586-0153