Healthcare Provider Details

I. General information

NPI: 1043241581
Provider Name (Legal Business Name): OREGON IMAGING CENTERS, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST #330
EUGENE OR
97401
US

IV. Provider business mailing address

1200 HILYARD ST STE 330
EUGENE OR
97401-8110
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-7134
  • Fax: 775-624-9774
Mailing address:
  • Phone: 541-687-7134
  • Fax: 458-215-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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:

# 1
Identifier052964
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: LUKE BREAZEAL
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 541-302-7771